1356517346 NPI number — DR. AUDREY ABATEMARCO D.P.M.

Table of content: (NPI 1356517346)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356517346 NPI number — DR. AUDREY ABATEMARCO D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. AUDREY ABATEMARCO D.P.M.
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:
1356517346
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
40 MONROE ST
Provider Second Line Business Mailing Address:
FI3
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10002-7793
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-227-0523
Provider Business Mailing Address Fax Number:
212-842-2451

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
63 CATHERINE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10038-1307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-227-0523
Provider Business Practice Location Address Fax Number:
212-842-2451
Provider Enumeration Date:
04/30/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ABATEMARCO
Authorized Official First Name:
AUDREY
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
DOCTOR OF PODIATRY MEDICINE
Authorized Official Telephone Number:
212-227-0523

Provider Taxonomy Codes

  • Taxonomy code: 332BC3200X , with the licence number:  N003693-2 , 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: PG7301 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0050079 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 10210444 . This is a "AMERIGROUP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1314314 . This is a "COVENTRY HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1345276440005 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P515833 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00877409 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4510217 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5798140001 . This is a "DMERC" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 050127000029 . This is a "FIDELIS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1314314 . This is a "FIRST HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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