1366514325 NPI number — BERNARD DONALD SKLANSKY MD

Table of content: ROBERT DOLINGA PA (NPI 1427262963)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366514325 NPI number — BERNARD DONALD SKLANSKY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SKLANSKY
Provider First Name:
BERNARD
Provider Middle Name:
DONALD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1366514325
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
833 NORTHERN BLVD
Provider Second Line Business Mailing Address:
SUITE 115
Provider Business Mailing Address City Name:
GREAT NECK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11021-5315
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-504-1800
Provider Business Mailing Address Fax Number:
516-466-7359

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
833 NORTHERN BLVD
Provider Second Line Business Practice Location Address:
SUITE 115
Provider Business Practice Location Address City Name:
GREAT NECK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11021-5315
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-504-1800
Provider Business Practice Location Address Fax Number:
516-466-7359
Provider Enumeration Date:
11/14/2006

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: 2086S0122X , with the licence number:  126845 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2086S0122X , with the licence number: ME94603 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2146213 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2616F1 . This is a "EMPIRE BC/BS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 802795 . This is a "AFFORDABLE" identifier . This identifiers is of the category "OTHER".
  • Identifier: AA45736 . This is a "MDNY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 38L671 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: CIGNA . This is a "0794605009" identifier . This identifiers is of the category "OTHER".
  • Identifier: AS774 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".




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