1417244633 NPI number — BARRY & FLORENCE FRIEDBERG JCC

Table of content: (NPI 1417244633)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417244633 NPI number — BARRY & FLORENCE FRIEDBERG JCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BARRY & FLORENCE FRIEDBERG JCC
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:
1417244633
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/06/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
08/17/2011
NPI Reactivation Date:
10/12/2011

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
310 NATIONAL BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONG BEACH
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11561-3326
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-431-2929
Provider Business Mailing Address Fax Number:
516-431-6278

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 NEIL CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OCEANSIDE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11572-5815
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-766-4341
Provider Business Practice Location Address Fax Number:
516-766-0513
Provider Enumeration Date:
07/08/2011

Additional Information

Authorized Official

Authorized Official Last Name:
HALLERMAN
Authorized Official First Name:
MARCY
Authorized Official Middle Name:
Authorized Official Title or Position:
SENIOR PROGRAM DIRECTOR
Authorized Official Telephone Number:
516-766-4441

Provider Taxonomy Codes

  • Taxonomy code: 251300000X , with the licence number:  00041165BCC , 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)





Copyright © 2007-2024 www.npivalidator.com