1003889700 NPI number — MARFATIA MEDICAL PLLC

Table of content: (NPI 1003889700)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003889700 NPI number — MARFATIA MEDICAL PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARFATIA MEDICAL PLLC
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:
1003889700
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
214 WYOMING ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WARSAW
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14569-9523
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-786-2769
Provider Business Mailing Address Fax Number:
585-786-0508

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5596 ROUTE 19A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CASTILE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14427-9757
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-493-9230
Provider Business Practice Location Address Fax Number:
585-786-0508
Provider Enumeration Date:
02/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COOPER
Authorized Official First Name:
RASHNA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
585-786-2769

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  224172 , 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: 000525403002 . This is a "BCBS WNY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0410493 . This is a "INDEPENDENT HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2710199 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 224172-7B . This is a "WORKERS COMPENSATION" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 106101BJ . This is a "PREFERRED CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7774326 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00010372202 . This is a "UNIVERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000525403003 . This is a "BCBS WNY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2514266 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01916687 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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