1215913983 NPI number — ASAF A GAVE MD

Table of content: ASAF A GAVE MD (NPI 1215913983)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215913983 NPI number — ASAF A GAVE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GAVE
Provider First Name:
ASAF
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1215913983
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/18/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 188
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARLBORO
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07746-0188
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-983-9530
Provider Business Mailing Address Fax Number:
718-370-7141

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BIMC 1ST AVENUE & 16TH STREET
Provider Second Line Business Practice Location Address:
3 SILVER RM 1
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-844-1026
Provider Business Practice Location Address Fax Number:
212-844-1785
Provider Enumeration Date:
12/15/2005

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: 2086S0102X , with the licence number:  25MA08203000 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0102X , with the licence number: 221253 , 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: 02654617 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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