1003982158 NPI number — LUCELLE M DELROSARIO MD

Table of content: LUCELLE M DELROSARIO MD (NPI 1003982158)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003982158 NPI number — LUCELLE M DELROSARIO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DELROSARIO
Provider First Name:
LUCELLE
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1003982158
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
161 EAST MAIN STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTINGTON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11743
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-427-3300
Provider Business Mailing Address Fax Number:
631-427-3412

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
161 EAST MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTINGTON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11743
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-427-3300
Provider Business Practice Location Address Fax Number:
631-427-3422
Provider Enumeration Date:
11/28/2006

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: 207V00000X , with the licence number:  1624361 , 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: 67D411 . This is a "NO BLUE CHOICE SR PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: SF0000406 . This is a "AFFORDABLE NETWORKS" identifier . This identifiers is of the category "OTHER".
  • Identifier: SF0000406 . This is a "SELECT PRO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 67D411 . This is a "BLUE CHOICE HMP POS PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2C4141 . This is a "HEALTHNET FORMERLY PHS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 67D4111 . This is a "BLUE CROSS FEDERAL EMPLOY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00961679 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2263840 . This is a "AETNA US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 672521 . This is a "EMPIRE PLAN UNITED HLTHCA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4199010 . This is a "AETNA PPO MANAGED CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: CP684 . This is a "OXFORD HLTH PLNS & ADVTGE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 13254 . This is a "NYTRA NO SMART CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 49801 . This is a "NO CIGNA HMP POS PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: CP684 . This is a "OXFORD LIBERTY PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: SF0000406 . This is a "FIRST HEALTH HLTH CARE CO" identifier . This identifiers is of the category "OTHER".
  • Identifier: AF01086 . This is a "MDNY NO FOCUS" identifier . This identifiers is of the category "OTHER".




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