1902063183 NPI number — RALPH B RABIN DPM LLC

Table of content: (NPI 1902063183)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902063183 NPI number — RALPH B RABIN DPM LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RALPH B RABIN DPM 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:
1902063183
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4550 N 51ST AVE
Provider Second Line Business Mailing Address:
SUITE 31
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85031-1708
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-846-9000
Provider Business Mailing Address Fax Number:
623-846-4021

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14044 W CAMELBACK RD
Provider Second Line Business Practice Location Address:
SUITE 114
Provider Business Practice Location Address City Name:
LITCHFIELD PARK
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85340-9428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-846-9000
Provider Business Practice Location Address Fax Number:
623-846-4021
Provider Enumeration Date:
05/16/2008

Additional Information

Authorized Official

Authorized Official Last Name:
RABIN
Authorized Official First Name:
RALPH
Authorized Official Middle Name:
B
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
623-846-9000

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 612151800 . This is a "FEDERAL WORKERSCOMP" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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