1346460599 NPI number — VA BRONX

Table of content: MS. LAURIE LEE PORTER FNP (NPI 1619021078)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346460599 NPI number — VA BRONX

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VA BRONX
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:
1346460599
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/28/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1143
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10116
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-774-0750
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 W KINGSBRIDGE RD
Provider Second Line Business Practice Location Address:
VA BRONX
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10468-3904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-584-9000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DILMEC
Authorized Official First Name:
IKBAL
Authorized Official Middle Name:
FATMA
Authorized Official Title or Position:
ATTENDING
Authorized Official Telephone Number:
718-584-9000

Provider Taxonomy Codes

  • Taxonomy code: 286500000X , with the licence number:  241207 , 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)





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