1194887406 NPI number — MRS. JOSEPHINE NONYE AUSTIN OPTICIAN

Table of content: MRS. JOSEPHINE NONYE AUSTIN OPTICIAN (NPI 1194887406)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194887406 NPI number — MRS. JOSEPHINE NONYE AUSTIN OPTICIAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AUSTIN
Provider First Name:
JOSEPHINE
Provider Middle Name:
NONYE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OPTICIAN
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:
1194887406
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/18/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10525 67TH AVE
Provider Second Line Business Mailing Address:
APARTMENT 1B
Provider Business Mailing Address City Name:
FOREST HILLS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11375-2161
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-793-1171
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
369 UTICA 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:
11213-5552
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-771-0078
Provider Business Practice Location Address Fax Number:
718-771-0071
Provider Enumeration Date:
12/14/2006

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: 156FX1800X , 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: 02823545 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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