1598859589 NPI number — ALBERT FAVATE MD

Table of content: ALBERT FAVATE MD (NPI 1598859589)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598859589 NPI number — ALBERT FAVATE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FAVATE
Provider First Name:
ALBERT
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1598859589
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/29/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
222 E 41ST ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10017-6739
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-263-7744
Provider Business Mailing Address Fax Number:
212-263-7721

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
222 E 41ST ST
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:
10017-6739
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-263-7744
Provider Business Practice Location Address Fax Number:
212-263-7721
Provider Enumeration Date:
10/03/2006

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: 2084N0400X , with the licence number:  161583 , 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)

  • Identifier: P3239454 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2814995 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6016100 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 161583 . This is a "STATE LICENSE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 043695466 . This is a "TAX ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 22621 . This is a "ELDERPLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3656599 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 548N01 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01602400 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3C6334 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4637585 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 548N02 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00072195 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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