1639127913 NPI number — SLR FPP UNIVERSITY MEDICAL PRACTICE ASSOCIATES

Table of content: (NPI 1639127913)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639127913 NPI number — SLR FPP UNIVERSITY MEDICAL PRACTICE ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SLR FPP UNIVERSITY MEDICAL PRACTICE 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:
UNIVERSITY MEDICAL PRACTICE ASSOCIATES
Provider Other Organization Name Type Code:
4
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:
1639127913
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/18/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1790 BROADWAY
Provider Second Line Business Mailing Address:
3RD FLOOR
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10019-1412
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-315-0144
Provider Business Mailing Address Fax Number:
212-315-0196

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1111 AMSTERDAM 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:
10025-1716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-315-0144
Provider Business Practice Location Address Fax Number:
212-315-0196
Provider Enumeration Date:
05/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JOSEPH
Authorized Official First Name:
NIGEL
Authorized Official Middle Name:
Authorized Official Title or Position:
VP,OPERATIONS
Authorized Official Telephone Number:
212-315-0144

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0001X ; 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: "N" .
  • Taxonomy code: 207RE0101X ; 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: 207RG0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RN0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RR0500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207UN0901X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 01898631 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6995501 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004725 . This is a "ADAERP" identifier . This identifiers is of the category "OTHER".




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