1063637361 NPI number — CAMILLE PHILIPPE MD, PC

Table of content: (NPI 1063637361)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063637361 NPI number — CAMILLE PHILIPPE MD, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAMILLE PHILIPPE MD, PC
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:
1063637361
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16405 HILLSIDE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JAMAICA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11432-4140
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-658-2448
Provider Business Mailing Address Fax Number:
718-658-2603

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16405 HILLSIDE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JAMAICA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11432-4140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-658-2448
Provider Business Practice Location Address Fax Number:
718-658-2603
Provider Enumeration Date:
04/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SANCIO
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE COORDINATOR
Authorized Official Telephone Number:
718-725-7031

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  147143 , 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: 170899 . This is a "GHI MEDICARE CHOICE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 68861 . This is a "MEDICARE-GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0068861 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 14714360NY . This is a "1199 NATIONAL BENEFIT FUND" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 170899 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: DP163 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 170899 . This is a "ELDERPLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 50013 . This is a "VYTRA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 58D471 . This is a "EMPIRE BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5C4094 . This is a "HEALTHNET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 147143B17 . This is a "HEALTHFIRST" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 170899 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 68861 . This is a "GHI-MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00924438 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 147143 . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 45817 . This is a "GHI HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: BKX033702 . This is a "AMERICHOICE BY UNITED HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 08P5792 . This is a "NEW YORK PRESBYTERIAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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