1003861725 NPI number — DR. JOHN J NOBILE MD

Table of content: DR. JOHN J NOBILE MD (NPI 1003861725)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003861725 NPI number — DR. JOHN J NOBILE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NOBILE
Provider First Name:
JOHN
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1003861725
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/19/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
131 W 35TH ST FL 7
Provider Second Line Business Mailing Address:
FLOOR 7
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10001-2111
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-475-8066
Provider Business Mailing Address Fax Number:
212-475-4175

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
131 W 35TH ST FL 7
Provider Second Line Business Practice Location Address:
FLOOR 7
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10001-2111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-475-8066
Provider Business Practice Location Address Fax Number:
212-475-4175
Provider Enumeration Date:
05/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  155591 , 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: 00931159 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: DO0835 . This is a "OXFORD ID #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 132789080 . This is a "TAX IDENTIFICATION #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0858495 . This is a "AETNA HMO ID #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0149041 . This is a "GHI PPO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 060012676 . This is a "RR MEDICARE ID #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: NJ5591 . This is a "ATLANTIS HEALTH PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01HCQV . This is a "GHI/MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: A400057743 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 41D363 . This is a "EMPIRE BCBS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 4238591 . This is a "AETNA PPO ID #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: CF7168 . This is a "RR MEDICARE GROUP #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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