1558693481 NPI number — PHELPS MEDICAL SERVICES, PC

Table of content: (NPI 1558693481)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558693481 NPI number — PHELPS MEDICAL SERVICES, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHELPS MEDICAL SERVICES, 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:
PHELPS MEDICAL ASSOCIATES, PC
Provider Other Organization Name Type Code:
3
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:
1558693481
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/10/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
155 WHITE PLAINS RD
Provider Second Line Business Mailing Address:
SUITE 210A PHELPS PROFESSIONAL BILLING
Provider Business Mailing Address City Name:
TARRYTOWN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10591-5523
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-269-1762
Provider Business Mailing Address Fax Number:
914-524-7985

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 N BROADWAY
Provider Second Line Business Practice Location Address:
PHELP MEDICAL ASSOCIATES
Provider Business Practice Location Address City Name:
SLEEPY HOLLOW
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10591-1020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-366-1000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/03/2010

Additional Information

Authorized Official

Authorized Official Last Name:
FALTZ
Authorized Official First Name:
LAWRENCE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
SHAREHOLDER, DIRECTOR, OFFICER
Authorized Official Telephone Number:
914-366-1000

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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