1336316348 NPI number — KUMP & SAYEGH FAMILY MED. SERVICES PC

Table of content: (NPI 1336316348)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336316348 NPI number — KUMP & SAYEGH FAMILY MED. SERVICES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KUMP & SAYEGH FAMILY MED. SERVICES PC
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:
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:
1336316348
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
140 ELM ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YONKERS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10701-3912
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-375-5206
Provider Business Mailing Address Fax Number:
914-375-5208

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
140 ELM ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YONKERS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10701-3912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-375-5206
Provider Business Practice Location Address Fax Number:
914-375-5208
Provider Enumeration Date:
05/09/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SOTO
Authorized Official First Name:
FLORA
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
718-548-4560

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0S05570C10 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01231589 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5900147 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: RC079F2030 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01230139 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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