1457344459 NPI number — DR. ERNEST GORDON DEPUEY III M.D.

Table of content: DR. ERNEST GORDON DEPUEY III M.D. (NPI 1457344459)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457344459 NPI number — DR. ERNEST GORDON DEPUEY III M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEPUEY
Provider First Name:
ERNEST
Provider Middle Name:
GORDON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1457344459
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/07/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 GUSTAVE L. LEVY PLACE
Provider Second Line Business Mailing Address:
BOX 1194
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10029-6574
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-241-8395
Provider Business Mailing Address Fax Number:
212-289-0092

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1780 BROADWAY
Provider Second Line Business Practice Location Address:
7TH FLOOR
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10019-1414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
211-315-0144
Provider Business Practice Location Address Fax Number:
212-315-0196
Provider Enumeration Date:
08/24/2005

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: 207U00000X , with the licence number:  178463-1 , 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)





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