1083777825 NPI number — ORTHOPAEDIC SURGICAL CONSULTANT PC

Table of content: (NPI 1083777825)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083777825 NPI number — ORTHOPAEDIC SURGICAL CONSULTANT PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHOPAEDIC SURGICAL CONSULTANT PC
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:
Provider Other Organization Name Type Code:
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:
1083777825
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/26/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9921 4TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11209-8347
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-238-5565
Provider Business Mailing Address Fax Number:
718-748-3526

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9921 4TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11209-8347
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-238-5565
Provider Business Practice Location Address Fax Number:
718-748-3526
Provider Enumeration Date:
12/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GOETZ
Authorized Official First Name:
MARIE
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
718-556-4700

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  186226 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 174400000X , with the licence number: 149171 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: NS2413 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P475372 . This is a "OXFORD INSURANCE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 186226COS . This is a "WORKERS COMP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1C2731 . This is a "PHS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: RV043D8610 . This is a "BLUE CROSS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 149171 . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: JL073G5810 . This is a "EMPIRE BLUE CROSS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0060015 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0814039 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: P475372 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00889818 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5710697012 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0119170 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 186226 . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 149171COS . This is a "WORKERS COMP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2C2126 . This is a "PHS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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