1164513172 NPI number — MRS. ROXANA E KORB LCSW-R

Table of content: MRS. ROXANA E KORB LCSW-R (NPI 1164513172)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164513172 NPI number — MRS. ROXANA E KORB LCSW-R

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KORB
Provider First Name:
ROXANA
Provider Middle Name:
E
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW-R
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RUZZA
Provider Other First Name:
ROXANA
Provider Other Middle Name:
E
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1164513172
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/02/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2443 LOGUE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH BELLMORE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11710
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-785-2178
Provider Business Mailing Address Fax Number:
516-785-2178

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4610 61ST ST
Provider Second Line Business Practice Location Address:
STE H
Provider Business Practice Location Address City Name:
WOODSIDE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11377-5766
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-415-4429
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/27/2006

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: 1041C0700X , with the licence number:  069469-1 , 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)

  • Identifier: 000150700101 . This is a "HEALTH PLUS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P2677456 . This is a "OXFORD HEALTH PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 298920P . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 064971-A37 . This is a "HEALTH FIRST" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 302566 . This is a "MHN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7464787 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1070480 . This is a "AFFINITY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 330632 . This is a "WELLCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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