1255449955 NPI number — EMPIRE ANSTHS MEDCL CONSLNTS

Table of content: (NPI 1255449955)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255449955 NPI number — EMPIRE ANSTHS MEDCL CONSLNTS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMPIRE ANSTHS MEDCL CONSLNTS
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:
EMPIRE ANESTHESIA MEDICAL CONSULTANTS, LLP
Provider Other Organization Name Type Code:
5
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:
1255449955
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
41 OAKTREE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NISKAYUNA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12309-1825
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-221-0646
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
41 OAKTREE LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NISKAYUNA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12309-1825
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-221-0646
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NAGARAJ
Authorized Official First Name:
HOSAHALLY
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
518-221-0646

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 367500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 5773443 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01546285 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 359677600 . This is a "USDOL" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5301669 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: E927 . This is a "CDPHP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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