1124023478 NPI number — MR. PIOTR SROKA P.T.

Table of content: MR. PIOTR SROKA P.T. (NPI 1124023478)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124023478 NPI number — MR. PIOTR SROKA P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SROKA
Provider First Name:
PIOTR
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
M

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:
1124023478
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
36 IMPERIAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILLER PLACE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11764-3222
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-476-7686
Provider Business Mailing Address Fax Number:
631-821-3462

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
517 OAK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COPIAGUE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11726-3244
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-789-3789
Provider Business Practice Location Address Fax Number:
631-789-3728
Provider Enumeration Date:
06/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  013642 , 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: 02020175 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: Q31391 . This is a "BLUECROSS BLUESHIELD-MP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6604263 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: AZ00952 . This is a "MDNY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: Q31392 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 819836 . This is a "MPN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 013642 . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 195036 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: A2517394 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com