1215379946 NPI number — HAVIVA NOVOGRODER MS SP ED

Table of content: HAVIVA NOVOGRODER MS SP ED (NPI 1215379946)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215379946 NPI number — HAVIVA NOVOGRODER MS SP ED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NOVOGRODER
Provider First Name:
HAVIVA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS SP ED
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KRAMER
Provider Other First Name:
HAVIVA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1215379946
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/23/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
530 GRAND ST
Provider Second Line Business Mailing Address:
F1E
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10002-4258
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-522-2122
Provider Business Mailing Address Fax Number:
718-522-6983

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
57 WILLOUGHBY ST
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:
11201-5257
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-522-2122
Provider Business Practice Location Address Fax Number:
718-522-6983
Provider Enumeration Date:
07/23/2013

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: 174400000X , with the licence number:  665553961 , 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)