1265768071 NPI number — ASAF A GAVE MD PC

Table of content: (NPI 1265768071)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265768071 NPI number — ASAF A GAVE MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASAF A GAVE MD PC
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:
1265768071
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/29/2009
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:
1110 SOUTH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STATEN ISLAND
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10314-3403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-983-9530
Provider Business Practice Location Address Fax Number:
718-370-7141
Provider Enumeration Date:
10/29/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GAVE
Authorized Official First Name:
ASAF
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
718-983-9530

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  221253 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • 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: "N" .
  • Taxonomy code: 2086S0127X , with the licence number: 221253 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)