1053483164 NPI number — JAY M PURVIN, DPM

Table of content: (NPI 1053483164)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053483164 NPI number — JAY M PURVIN, DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAY M PURVIN, DPM
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:
1053483164
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
336 CEDAR LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST MEADOW
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11554-2714
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-489-1950
Provider Business Mailing Address Fax Number:
516-489-6861

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
336 CEDAR LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST MEADOW
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11554-2714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-489-1950
Provider Business Practice Location Address Fax Number:
516-489-6861
Provider Enumeration Date:
11/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PURVIN
Authorized Official First Name:
JAY
Authorized Official Middle Name:
M
Authorized Official Title or Position:
DPM
Authorized Official Telephone Number:
516-489-1950

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  NO029711 , 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: 040426008382 . This is a "FIDELIS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: AS1651 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0028525 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00406217 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0758507 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1161608 . This is a "HORIZON" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: N02971-A13 . This is a "HEALTHFIRST" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 303916 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6283312-006 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 442480195 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1C1904 . This is a "HEALTHNET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 36608P . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 4514751 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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