1356303267 NPI number — DR. POLYNA LEIBINSKY-RAMOS DDS

Table of content: DR. POLYNA LEIBINSKY-RAMOS DDS (NPI 1356303267)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356303267 NPI number — DR. POLYNA LEIBINSKY-RAMOS DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEIBINSKY-RAMOS
Provider First Name:
POLYNA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

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:
1356303267
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1300 EL PASEO RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS CRUCES
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88001-6024
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-667-7546
Provider Business Mailing Address Fax Number:
575-525-9099

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1300 EL PASEO RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS CRUCES
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88001-6024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-667-7546
Provider Business Practice Location Address Fax Number:
575-525-9099
Provider Enumeration Date:
04/05/2006

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: 1223G0001X , with the licence number:  045287-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 122300000X , with the licence number: DD3327 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: 25760 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 01584674 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 37087274 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".