1891848461 NPI number — BIMC FACULTY PRACTICE

Table of content: (NPI 1891848461)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891848461 NPI number — BIMC FACULTY PRACTICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BIMC FACULTY PRACTICE
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:
1891848461
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/03/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 95000-2445
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19195-2445
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-844-6890
Provider Business Mailing Address Fax Number:
212-844-6437

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 UNION SQ E
Provider Second Line Business Practice Location Address:
SUITE 2Q
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10003-3314
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-844-8888
Provider Business Practice Location Address Fax Number:
212-844-6437
Provider Enumeration Date:
01/18/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HACKETT
Authorized Official First Name:
DEBORAH
Authorized Official Middle Name:
Authorized Official Title or Position:
VP
Authorized Official Telephone Number:
212-256-3424

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084N0402X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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