1114965019 NPI number — YULYA TIMASHPOLSKY M.D.

Table of content: CRAIG O'NEIL CAMPBELL M.D. (NPI 1508186867)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114965019 NPI number — YULYA TIMASHPOLSKY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TIMASHPOLSKY
Provider First Name:
YULYA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1114965019
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
60 MADISON AVE FL 5
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10010-1600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-545-2400
Provider Business Mailing Address Fax Number:
646-312-0481

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4215 3RD AVE
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10457-4501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-294-5891
Provider Business Practice Location Address Fax Number:
718-294-2468
Provider Enumeration Date:
06/03/2006

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: 207R00000X , with the licence number:  80340 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 247050 , 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: 20994 . This is a "BCBSRI" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 771708 . This is a "TUFTS HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 36686 . This is a "CHILDREN'S MEDICAL SEC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 66185 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0002592 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: B10436301 . This is a "CIGNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 110228103 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 964303-01 . This is a "NETWORK HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 00695941 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0401906 . This is a "UNITED HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 042675800 . This is a "HUMANA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2120544 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: J31322 . This is a "BCBSMA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 004436 . This is a "SENIOR WHOLE HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 406113 . This is a "BCBSRIBLUECHIP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 000000024045 . This is a "BMC HEALTHNET" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 3144445 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5326938-002 . This is a "CIGNA PAL" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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