1063416501 NPI number — DR. WILLIAM L. DAVIS JR. MD

Table of content: SARAH NGUYEN PHARMD (NPI 1922287945)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063416501 NPI number — DR. WILLIAM L. DAVIS JR. MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVIS
Provider First Name:
WILLIAM
Provider Middle Name:
L.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
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:
1063416501
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/29/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
507 AIRPORT EXECUTIVE PARK
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NANUET
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10954-5238
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-262-5313
Provider Business Mailing Address Fax Number:
845-262-5330

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
327 ROUTE 59
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AIRMONT
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10952
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-356-2900
Provider Business Practice Location Address Fax Number:
845-356-7797
Provider Enumeration Date:
06/13/2005

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: 207XX0005X , with the licence number:  213531 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207XX0005X , with the licence number: 25MA07797000 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 361012 . This is a "MVP (MONROE)" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5956750 . This is a "AETNA PPO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01948512 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2695H1 . This is a "EMPIRE BCBS (STONY POINT)" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2695H3 . This is a "EMPIRE BCBS (AIRMONT)" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5902684 . This is a "GHI PPO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 132721370 . This is a "TAX ID#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0D1365 . This is a "HEALTHNET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 200037035 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2695H2 . This is a "EMPIRE BCBS (MONROE)" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2176547 . This is a "AETNA HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 361012 . This is a "MVP (AIRMONT/STONY POINT)" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P1310314 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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