1235303066 NPI number — MYRNA MATTAR N.P.

Table of content: MYRNA MATTAR N.P. (NPI 1235303066)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235303066 NPI number — MYRNA MATTAR N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MATTAR
Provider First Name:
MYRNA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
N.P.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DESVARIEUX
Provider Other First Name:
MYRNA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
FNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1235303066
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/22/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
ONE PENN PLAZA
Provider Second Line Business Mailing Address:
7TH FLOOR, SUITE 725
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10119-0206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-842-2478
Provider Business Mailing Address Fax Number:
212-216-6606

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 PENN PLZ
Provider Second Line Business Practice Location Address:
7TH FLOOR, SUITE 725
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10119-0002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-842-2478
Provider Business Practice Location Address Fax Number:
212-216-6606
Provider Enumeration Date:
04/14/2008

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: 363LF0000X , with the licence number:  F335366 , 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: F335366 . This is a "NY STATE NP LICENSE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".