1366695207 NPI number — PHILLIPS HILL PAIN MGMT., PC

Table of content: (NPI 1366695207)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366695207 NPI number — PHILLIPS HILL PAIN MGMT., PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHILLIPS HILL PAIN MGMT., 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:
1366695207
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 514
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTVALE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07645
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-634-5656
Provider Business Mailing Address Fax Number:
845-634-0596

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 PHILLIPS HILL RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW CITY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10956
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-634-5656
Provider Business Practice Location Address Fax Number:
845-634-0596
Provider Enumeration Date:
10/23/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DISCENZA
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
845-709-2274

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  140670 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0000X , with the licence number: MA045663 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: WYYZR1 . This is a "NY PTAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 095248 . This is a "NJ PTAN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".