1306955547 NPI number — STEPHAN E UNGAR PT

Table of content: STEPHAN E UNGAR PT (NPI 1306955547)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306955547 NPI number — STEPHAN E UNGAR PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
UNGAR
Provider First Name:
STEPHAN
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
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:
1306955547
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
440 WAVERLY AVE STE 5
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PATCHOGUE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11772-1597
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-758-5700
Provider Business Mailing Address Fax Number:
631-758-7005

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
440 WAVERLY AVE STE 5
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PATCHOGUE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11772-1597
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-758-5700
Provider Business Practice Location Address Fax Number:
631-758-7005
Provider Enumeration Date:
08/30/2006

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: 225100000X , with the licence number:  011026-1 , 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: 139551P . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 14378140 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2788 . This is a "HERITAGE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P1939994 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 43641478 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 65002050 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 102481 . This is a "VYTRA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: SF0003105 . This is a "SELECT PRO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2287876 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 11350404040 . This is a "NO FAULT" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1259717 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: Q86011 . This is a "EMPIRE BLUE CROSS / SHIEL" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: AZ00653 . This is a "MDNY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com