1144387630 NPI number — DR. JOHN D MASTROBATTISTA MD

Table of content: DR. JOHN D MASTROBATTISTA MD (NPI 1144387630)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144387630 NPI number — DR. JOHN D MASTROBATTISTA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MASTROBATTISTA
Provider First Name:
JOHN
Provider Middle Name:
D
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1144387630
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
169 E 62ND ST
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:
10065-7605
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-688-9365
Provider Business Mailing Address Fax Number:
612-688-9372

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
169 E 62ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10065-7605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-688-9365
Provider Business Practice Location Address Fax Number:
612-688-9372
Provider Enumeration Date:
01/03/2007

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: 207W00000X , with the licence number:  178843 , 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: 160940 . This is a "ELDERPLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0400339 . This is a "GHS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010178843NY00 . This is a "ANTHEM HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 80314 . This is a "UNICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 462099 . This is a "AETNA US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 09732P . This is a "HIP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 178843A26 . This is a "HEALTHFIRST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01500861 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: P471036 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: M58843 . This is a "ATLANTIS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1058199 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 57K011 . This is a "EMPIRE BLUE CROSS BLUE SH" identifier . This identifiers is of the category "OTHER".




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