1366814659 NPI number — UNITED PRESBYTERIAN & REFORMED ADULT MINISTRIES

Table of content: (NPI 1366814659)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366814659 NPI number — UNITED PRESBYTERIAN & REFORMED ADULT MINISTRIES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNITED PRESBYTERIAN & REFORMED ADULT MINISTRIES
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:
UNITED LIFELINE
Provider Other Organization Name Type Code:
3
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:
1366814659
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/26/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 411
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODBURY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11797-0411
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-364-3401
Provider Business Mailing Address Fax Number:
516-364-3404

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
322 BROADWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BETHPAGE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11714-3011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-364-3401
Provider Business Practice Location Address Fax Number:
516-364-3404
Provider Enumeration Date:
10/26/2015

Additional Information

Authorized Official

Authorized Official Last Name:
KURTZ
Authorized Official First Name:
DOUGLAS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
516-364-3401

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01364378 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 209205 . This is a "NOT FOR PROFIT" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com