1316935406 NPI number — DR. RUFUS EDGAR SADLER M.D.

Table of content: DR. RUFUS EDGAR SADLER M.D. (NPI 1316935406)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316935406 NPI number — DR. RUFUS EDGAR SADLER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SADLER
Provider First Name:
RUFUS
Provider Middle Name:
EDGAR
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.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:
1316935406
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/30/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
392 BEDFORD PARK BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRONX
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10458-2415
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-364-0100
Provider Business Mailing Address Fax Number:
718-295-9220

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3750 THIRD AVE
Provider Second Line Business Practice Location Address:
DMG
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10456-2102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-588-0100
Provider Business Practice Location Address Fax Number:
646-568-2982
Provider Enumeration Date:
10/12/2005

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: 207R00000X , with the licence number:  163783 , 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: MA45747 . This is a "LICENSE NUMBER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 00909462 . This is a "MEDICAID PROVIDER NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 163783 . This is a "LICENSE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 53D771 . This is a "MEDICARE PROVIDER NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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