1558374397 NPI number — NEW YORK CRITICAL CARE ASSOCIATES

Table of content: (NPI 1558374397)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558374397 NPI number — NEW YORK CRITICAL CARE ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW YORK CRITICAL CARE ASSOCIATES
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:
1558374397
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/02/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 RUBINS CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DIX HILLS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11746-4875
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
550 1ST AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10016-6402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-684-6605
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KAUFMAN
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
212-684-6605

Provider Taxonomy Codes

  • Taxonomy code: 207LC0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RP1001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 01738063 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: NY0W4L5610 . This is a "BLUE SHIELD" identifier . This identifiers is of the category "OTHER".




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