1083931612 NPI number — PULMONARY CRITICAL CARE & SLEEP MEDICINE OF NASSAU P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083931612 NPI number — PULMONARY CRITICAL CARE & SLEEP MEDICINE OF NASSAU P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PULMONARY CRITICAL CARE & SLEEP MEDICINE OF NASSAU P.C.
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:
1083931612
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
65-11 BOOTH STREET
Provider Second Line Business Mailing Address:
SUITE 1C
Provider Business Mailing Address City Name:
REGO PARK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11374-4184
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-806-1434
Provider Business Mailing Address Fax Number:
718-806-1435

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
250-12 HILLSIDE AVENUE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
BELLEROSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11426-2139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-347-0411
Provider Business Practice Location Address Fax Number:
718-347-0455
Provider Enumeration Date:
04/21/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MEHRISHI
Authorized Official First Name:
SANDEEP
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
718-347-0411

Provider Taxonomy Codes

  • Taxonomy code: 207RS0012X , with the licence number:  241650 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 241650 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , with the licence number: 241650 , 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)





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