1023053527 NPI number — NEWYORK-PRESBYTERIAN-QUEENS

Table of content: (NPI 1023053527)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023053527 NPI number — NEWYORK-PRESBYTERIAN-QUEENS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEWYORK-PRESBYTERIAN-QUEENS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
TRUDE WEISHAUPT MEMORIAL SATELLITE DIALYSIS CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023053527
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/03/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5928 174TH ST
Provider Second Line Business Mailing Address:
FRESH MEADOWS
Provider Business Mailing Address City Name:
FRESH MEADOWS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11365-1539
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-670-1276
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5928 174TH ST
Provider Second Line Business Practice Location Address:
FRESH MEADOWS
Provider Business Practice Location Address City Name:
FRESH MEADOWS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11365-1539
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-670-1276
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LANTOS
Authorized Official First Name:
PHYLLIS
Authorized Official Middle Name:
R.F.
Authorized Official Title or Position:
EVP, CFO AND TREASURER
Authorized Official Telephone Number:
212-746-7905

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X , with the licence number:  7003010H PFI 2670 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 333547 . This is a "MEDICARE PTAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00244133 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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