1659510709 NPI number — DR. DEBORA SIMCHA SEMEL M.D.

Table of content: DR. DEBORA SIMCHA SEMEL M.D. (NPI 1659510709)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659510709 NPI number — DR. DEBORA SIMCHA SEMEL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEMEL
Provider First Name:
DEBORA
Provider Middle Name:
SIMCHA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BERNHEIM
Provider Other First Name:
DEBORA
Provider Other Middle Name:
SIMCHA
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1659510709
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/14/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26508 74TH AVE APT F1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLEN OAKS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11004-1167
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-627-3542
Provider Business Mailing Address Fax Number:
516-627-3542

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26508 74TH AVE APT F1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLEN OAKS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11004-1167
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-627-3542
Provider Business Practice Location Address Fax Number:
516-627-3542
Provider Enumeration Date:
02/12/2009

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: 208000000X , with the licence number:  249389-1 , 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)