1477895100 NPI number — DR. FEBY A GEWARGY I 07/16/83

Table of content: DR. FEBY A GEWARGY I 07/16/83 (NPI 1477895100)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477895100 NPI number — DR. FEBY A GEWARGY I 07/16/83

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GEWARGY
Provider First Name:
FEBY
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
I
Provider Credential Text:
07/16/83
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GEWARGY
Provider Other First Name:
FEBY
Provider Other Middle Name:
ANEES
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
I
Provider Other Credential Text:
07/16/83
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1477895100
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/20/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
73 FERRY ST
Provider Second Line Business Mailing Address:
NEWARK
Provider Business Mailing Address City Name:
HUDSON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07002-0700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
347-681-5054
Provider Business Mailing Address Fax Number:
347-681-5054

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
73 FERRY ST
Provider Second Line Business Practice Location Address:
745 BERGEN AVE
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07105-1831
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-681-5054
Provider Business Practice Location Address Fax Number:
347-681-5853
Provider Enumeration Date:
03/20/2013

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: 183500000X , with the licence number:  28RI03548300 , 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)