1891939195 NPI number — ARIA PROFESSIONAL GROUP LLC

Table of content: (NPI 1891939195)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891939195 NPI number — ARIA PROFESSIONAL GROUP LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARIA PROFESSIONAL GROUP LLC
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:
1891939195
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/30/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13731 METROPOLIS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT MYERS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33912-7150
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-333-2742
Provider Business Mailing Address Fax Number:
239-333-4329

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13731 METROPOLIS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT MYERS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33912-7150
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-333-2742
Provider Business Practice Location Address Fax Number:
239-333-4329
Provider Enumeration Date:
04/30/2009

Additional Information

Authorized Official

Authorized Official Last Name:
SHAH
Authorized Official First Name:
SAURIN
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER/MANAGER
Authorized Official Telephone Number:
239-333-2742

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  ME82826 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: ME82826 . This is a "MEDICAL LICENSE NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com