1326288978 NPI number — DR ROBERT N PRICHEP PHYSICIAN PC

Table of content: (NPI 1326288978)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326288978 NPI number — DR ROBERT N PRICHEP PHYSICIAN PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR ROBERT N PRICHEP PHYSICIAN 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:
1326288978
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/29/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
286 SILLS RD
Provider Second Line Business Mailing Address:
SUITE 5
Provider Business Mailing Address City Name:
EAST PATCHOGUE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11772-8810
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-654-9090
Provider Business Mailing Address Fax Number:
631-654-0265

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
286 SILLS RD
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
EAST PATCHOGUE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11772-8810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-654-9090
Provider Business Practice Location Address Fax Number:
631-654-0265
Provider Enumeration Date:
02/23/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CELMS
Authorized Official First Name:
TONI
Authorized Official Middle Name:
G
Authorized Official Title or Position:
BILLING ADMINISTRATOR
Authorized Official Telephone Number:
631-737-4168

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  148405 , 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: 00962092 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".