1245274620 NPI number — DR. BRIAN POWELL O.D.

Table of content: DR. BRIAN POWELL O.D. (NPI 1245274620)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245274620 NPI number — DR. BRIAN POWELL O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POWELL
Provider First Name:
BRIAN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

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:
1245274620
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/27/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
44 HOOSE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FISHKILL
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12524-3400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-896-2427
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
969 MAIN ST STE H
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FISHKILL
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12524-1791
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-896-6700
Provider Business Practice Location Address Fax Number:
845-896-6882
Provider Enumeration Date:
06/15/2006

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: 152W00000X , with the licence number:  VUT005959 , 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: 161526023 . This is a "POMCO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P00439185 . This is a "PALMETTO GBA RAILROAD MED" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5C8144 . This is a "HEALTHNET INS. OF NY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P3704610 . This is a "OXFORD HEALTH INSURANCE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000412569001 . This is a "HEALTHNOW OF N.Y." identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 390887 . This is a "M V P" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: C480C1 . This is a "EMPIRE BC/BS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 10118806 . This is a "C D P H P" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1343583 . This is a "AETNA HEALTH INSURANCE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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