1205327913 NPI number — SHERIDAN RX INC

Table of content: DR. JAMES MICHAEL RIOPELLE MD (NPI 1013909910)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205327913 NPI number — SHERIDAN RX INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHERIDAN RX INC
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:
6
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:
1205327913
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/31/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1030 SHERIDAN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRONX
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10456-6100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-502-9540
Provider Business Mailing Address Fax Number:
718-502-8045

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1030 SHERIDAN 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:
10456
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-502-9540
Provider Business Practice Location Address Fax Number:
718-502-8045
Provider Enumeration Date:
05/29/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ISKIYAYEVA
Authorized Official First Name:
SVETLANA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
718-502-9540

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2178021 . This is a "PK" identifier . This identifiers is of the category "OTHER".