1124092747 NPI number — JAMES R HESS DO

Table of content: JAMES R HESS DO (NPI 1124092747)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124092747 NPI number — JAMES R HESS DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HESS
Provider First Name:
JAMES
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1124092747
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/29/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
45 RESEARCH WAY STE 208A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST SETAUKET
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11733-6401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-675-2125
Provider Business Mailing Address Fax Number:
631-675-2624

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 MOTOR PKWY STE C-16
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAUPPAUGE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11788-5114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-978-7633
Provider Business Practice Location Address Fax Number:
631-621-4119
Provider Enumeration Date:
02/13/2006

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: 207RE0101X , with the licence number:  0102201731 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RE0101X , with the licence number: 228277-1 , 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)