1356693394 NPI number — FIRST STATE INTERNAL MEDICINE PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356693394 NPI number — FIRST STATE INTERNAL MEDICINE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FIRST STATE INTERNAL MEDICINE 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:
1356693394
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/12/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1208 HURLOCK CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEAR
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19701-4960
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-261-2269
Provider Business Mailing Address Fax Number:
302-834-2184

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
102 SLEEPY HOLLOW DR
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
MIDDLETOWN
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19709-5841
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-261-2269
Provider Business Practice Location Address Fax Number:
302-834-2184
Provider Enumeration Date:
10/14/2012

Additional Information

Authorized Official

Authorized Official Last Name:
KHANDELWAL
Authorized Official First Name:
RASHMI
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
302-753-8204

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X , with the licence number:  2012605820 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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