1356311971 NPI number — DEAN J LIMERI MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356311971 NPI number — DEAN J LIMERI MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

LIMERI

Provider First Name:

DEAN

Provider Middle Name:

J

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

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:

1356311971

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

08/09/2011

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

600 MCCLELLAN ST

Provider Second Line Business Mailing Address:

2 WEST

Provider Business Mailing Address City Name:

SCHENECTADY

Provider Business Mailing Address State Name:

NY

Provider Business Mailing Address Postal Code:

12304-1009

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

518-347-5400

Provider Business Mailing Address Fax Number:

518-347-5222

Provider First Line Business Practice Location Address:

460 SARATOGA RD

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

SCOTIA

Provider Business Practice Location Address State Name:

NY

Provider Business Practice Location Address Postal Code:

12302-5219

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

518-243-3360

Provider Business Practice Location Address Fax Number:

518-243-3375

Provider Enumeration Date:

01/25/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207R00000X , with the licence number:  158937 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 208000000X , with the licence number: 158937 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 000401287001 . This is a "BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 158937 . This is a "WORKERS' COMP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 01036575 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
• Identifier: 26141 . This is a "MVP - PEDIATRICS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 5534380 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 10001193 . This is a "CDPHP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 11311 . This is a "MVP-INTERNAL MEDICINE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 55E181 . This is a "BLUE CROSS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 040426006675 . This is a "FIDELIS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 10494721 . This is a "CAQH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".