1225059215 NPI number — EAST END PULMONARY CARE, P.C.

Table of content: (NPI 1225059215)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225059215 NPI number — EAST END PULMONARY CARE, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAST END PULMONARY CARE, P.C.
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:
1225059215
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/05/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1025 ROANOKE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIVERHEAD
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11901-2735
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-727-6717
Provider Business Mailing Address Fax Number:
631-953-0204

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1025 ROANOKE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIVERHEAD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11901-2735
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-727-6717
Provider Business Practice Location Address Fax Number:
631-953-0204
Provider Enumeration Date:
07/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MASSIAH
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
COLIN
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
631-727-6717

Provider Taxonomy Codes

  • Taxonomy code: 207RC0200X , with the licence number:  235602 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , with the licence number: 235602 , 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: 223227P . This is a "HIP ID #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P00260961 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1861894 . This is a "CIGNA ID #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2144859 . This is a "VYTRA ID #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 299268 . This is a "GHI ID #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 235602OW . This is a "WORKER'S COMP ID #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 8VO44 . This is a "BCBS GROUP #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: AA73450 . This is a "MDNY ID #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2744154 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com