1649439795 NPI number — MS. MARION E GROETCH MS RD CDN

Table of content: MS. MARION E GROETCH MS RD CDN (NPI 1649439795)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649439795 NPI number — MS. MARION E GROETCH MS RD CDN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GROETCH
Provider First Name:
MARION
Provider Middle Name:
E
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MS RD CDN
Provider Gender Code:
F

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:
1649439795
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 GUSTAVE L LEVY PLACE BOX 1198
Provider Second Line Business Mailing Address:
MOUNT SINAI SCHOOL OF MEDICINE
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10029-6574
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-241-8925
Provider Business Mailing Address Fax Number:
212-426-1902

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5 E 98TH ST
Provider Second Line Business Practice Location Address:
MOUNT SINAI SCHOOL OF MEDICINE
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10029-6501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-241-8925
Provider Business Practice Location Address Fax Number:
212-426-1902
Provider Enumeration Date:
06/04/2008

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: 133V00000X , with the licence number:  717116 , 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)





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