1780751776 NPI number — MEDICAL HEALTH ASSOCIATES OF BELLEROSE PC

Table of content: (NPI 1780751776)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780751776 NPI number — MEDICAL HEALTH ASSOCIATES OF BELLEROSE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICAL HEALTH ASSOCIATES OF BELLEROSE 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:
FAMILY MEDICAL MD 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:
1780751776
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24818 UNION TURNPIKE
Provider Second Line Business Mailing Address:
GROUND FLOOR
Provider Business Mailing Address City Name:
BELLEROSE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11426
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-347-7621
Provider Business Mailing Address Fax Number:
718-347-4564

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24818 UNION TURNPIKE
Provider Second Line Business Practice Location Address:
GROUND FLOOR
Provider Business Practice Location Address City Name:
BELLEROSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11426
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-347-7621
Provider Business Practice Location Address Fax Number:
718-347-4564
Provider Enumeration Date:
11/29/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BASILEO
Authorized Official First Name:
SANTO
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
718-347-7621

Provider Taxonomy Codes

  • Taxonomy code: 173000000X , with the licence number:  184113-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 173000000X , with the licence number: 176820-2 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 173000000X , with the licence number: F304231 , 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)