1962770016 NPI number — NY URGENT CARE PRACTICE, P.C.

Table of content: (NPI 1962770016)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962770016 NPI number — NY URGENT CARE PRACTICE, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NY URGENT CARE PRACTICE, P.C.
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:
FIVE STAR URGENT CARE BIG FLATS
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:
1962770016
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 500
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELLICOTTVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14731-0500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-699-9032
Provider Business Mailing Address Fax Number:
716-699-9035

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
830 COUNTY ROAD 64
Provider Second Line Business Practice Location Address:
#19C
Provider Business Practice Location Address City Name:
ELMIRA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14903-9719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-846-2030
Provider Business Practice Location Address Fax Number:
607-873-7457
Provider Enumeration Date:
12/05/2011

Additional Information

Authorized Official

Authorized Official Last Name:
RADFORD
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
716-699-9032

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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