1265479489 NPI number — MORRIS NISSIM NEGRIN MD

Table of content: (NPI 1265733018)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265479489 NPI number — MORRIS NISSIM NEGRIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEGRIN
Provider First Name:
MORRIS
Provider Middle Name:
NISSIM
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1265479489
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/12/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 100806
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30384-0806
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-901-2102
Provider Business Mailing Address Fax Number:
423-892-5838

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 WEST OAK STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KISSIMMEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34741-4924
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-846-2266
Provider Business Practice Location Address Fax Number:
407-518-3616
Provider Enumeration Date:
05/31/2006

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: 207L00000X , with the licence number:  ME71289 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 41879 . This is a "BLUE CROSS BLUE SHIELD FL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 258088800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0500091085 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 109626300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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