1174772735 NPI number — DR. PHILIPPA JAYNE CHEETHAM MBCHB (HONS) MD MRCS

Table of content: DR. PHILIPPA JAYNE CHEETHAM MBCHB (HONS) MD MRCS (NPI 1174772735)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174772735 NPI number — DR. PHILIPPA JAYNE CHEETHAM MBCHB (HONS) MD MRCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHEETHAM
Provider First Name:
PHILIPPA
Provider Middle Name:
JAYNE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MBCHB (HONS) MD MRCS
Provider Gender Code:
F

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:
1174772735
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 OLD COUNTRY RD
Provider Second Line Business Mailing Address:
SUITE 520
Provider Business Mailing Address City Name:
MINEOLA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11501-4235
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
646-216-7979
Provider Business Mailing Address Fax Number:
516-216-7978

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8002 KEW GARDENS RD
Provider Second Line Business Practice Location Address:
SUITE 323
Provider Business Practice Location Address City Name:
KEW GARDENS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11415-3600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
646-216-7979
Provider Business Practice Location Address Fax Number:
646-216-7978
Provider Enumeration Date:
09/18/2008

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: 208800000X , with the licence number:  267290 , 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)





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