1154789451 NPI number — ROYAL MEDICAL CENTER FOR WOMEN PC

Table of content: (NPI 1154789451)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154789451 NPI number — ROYAL MEDICAL CENTER FOR WOMEN PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROYAL MEDICAL CENTER FOR WOMEN PC
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:
1154789451
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/02/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
687 LENOX RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11203-2218
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-221-5001
Provider Business Mailing Address Fax Number:
718-221-5505

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3225 FENTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10469-2801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-221-5001
Provider Business Practice Location Address Fax Number:
718-221-5505
Provider Enumeration Date:
02/02/2016

Additional Information

Authorized Official

Authorized Official Last Name:
JACK
Authorized Official First Name:
KELVIN
Authorized Official Middle Name:
K
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
718-221-5001

Provider Taxonomy Codes

  • Taxonomy code: 207VG0400X , with the licence number:  272090 , 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: 02778018 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com