1255525788 NPI number — CHARLES MORELLI DPM P.C.

Table of content: (NPI 1255525788)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255525788 NPI number — CHARLES MORELLI DPM P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHARLES MORELLI DPM 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:
SOUND SHORE PODIATRY
Provider Other Organization Name Type Code:
3
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:
1255525788
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/31/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
910 E BOSTON POST RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAMARONECK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10543-4109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-835-6604
Provider Business Mailing Address Fax Number:
914-835-6913

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
910 E BOSTON POST RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAMARONECK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10543-4109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-835-6604
Provider Business Practice Location Address Fax Number:
914-835-6913
Provider Enumeration Date:
08/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MORELLI
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
914-835-6604

Provider Taxonomy Codes

  • Taxonomy code: 213ES0131X , with the licence number:  N004812 , 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: 01537026 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 480023413 . This is a "RAILROAD MEDICARE ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P08781 . This is a "EMPIRE ID NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P672271 . This is a "OXFORD ID NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1C5826 . This is a "HEALTHNET ID NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com