1821294711 NPI number — NORTH COAST MEDICAL ASSOCIATES PLLC

Table of content: (NPI 1821294711)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821294711 NPI number — NORTH COAST MEDICAL ASSOCIATES PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH COAST MEDICAL ASSOCIATES PLLC
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:
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:
1821294711
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/17/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
415 PORT WASHINGTON BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORT WASHINGTON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11050-4201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-883-0218
Provider Business Mailing Address Fax Number:
516-767-0894

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
415 PORT WASHINGTON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT WASHINGTON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11050-4201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-883-0218
Provider Business Practice Location Address Fax Number:
516-767-0894
Provider Enumeration Date:
06/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SIASOCO
Authorized Official First Name:
ANNA
Authorized Official Middle Name:
LIZZA
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
516-883-0218

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  236459 , 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: 3363P1 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6C0603 . This is a "HEALTH NET OF NORTHEAST" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: SA6459 . This is a "ATLANTIS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P3698445 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5880458 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5995775 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: AA73558A . This is a "MDNY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 286811P . This is a "HIP" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 9412517 . This is a "PHCS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 051903998 . This is a "MAGNACARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2554307 . This is a "UHC" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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