1083664114 NPI number — BRUCE R HANKIN OD

Table of content: BRUCE R HANKIN OD (NPI 1083664114)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083664114 NPI number — BRUCE R HANKIN OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HANKIN
Provider First Name:
BRUCE
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OD
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:
1083664114
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2160 PENFIELD RD
Provider Second Line Business Mailing Address:
SUITE #100
Provider Business Mailing Address City Name:
PENFIELD
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14526-1712
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-377-7090
Provider Business Mailing Address Fax Number:
585-377-3155

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2160 PENFIELD RD
Provider Second Line Business Practice Location Address:
SUITE #100
Provider Business Practice Location Address City Name:
PENFIELD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14526-1712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-377-7090
Provider Business Practice Location Address Fax Number:
585-377-3155
Provider Enumeration Date:
05/11/2006

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: 152W00000X , with the licence number:  VUT004041 , 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: 100135CS . This is a "PREFERRED CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1568685113 . This is a "MEDICARE NSC" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5474311 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".