1215084512 NPI number — JOSE F. CERVANTES JR. MD PLLC

Table of content: (NPI 1215084512)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215084512 NPI number — JOSE F. CERVANTES JR. MD PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOSE F. CERVANTES JR. MD PLLC
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:
1215084512
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/26/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12239 135TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH OZONE PARK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11420-3238
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-835-1056
Provider Business Mailing Address Fax Number:
718-835-2769

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12239 135TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH OZONE PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11420-3238
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-835-1056
Provider Business Practice Location Address Fax Number:
718-835-2769
Provider Enumeration Date:
01/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CERVANTES
Authorized Official First Name:
JOSE
Authorized Official Middle Name:
FELIPE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
718-835-1056

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  159085 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0003X , with the licence number: 159085 , 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: 01013372 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 137245 . This is a "WELLCARE OF NY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 159085 . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 159085-B17 . This is a "HEALTH FIRST" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2605940 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P00000070683 . This is a "GHI MEDICARE CHOICE PPO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0553273 . This is a "CIGNA HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1000016335 . This is a "AFFINITY HEALTH PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2Z603 . This is a "EMPIRE BLUE CROSS BLUE SH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 78371 . This is a "VYTRA HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P00388302 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1201510 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1569153-1 . This is a "1199 NATIONAL BENEFIT FUN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P3715361 . This is a "OXFORD HEALTH PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 160124 . This is a "ELDERPLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6C0541 . This is a "HEALTHNET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7299185 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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