1376791277 NPI number — DR. HENOCK T. WOLDE-SEMAIT M.D.

Table of content: DR. HENOCK T. WOLDE-SEMAIT M.D. (NPI 1376791277)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376791277 NPI number — DR. HENOCK T. WOLDE-SEMAIT M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOLDE-SEMAIT
Provider First Name:
HENOCK
Provider Middle Name:
T.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1376791277
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/19/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1300 FRANKLIN AVE STE UL3A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GARDEN CITY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11530-1885
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-663-1108
Provider Business Mailing Address Fax Number:
516-663-8166

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6701 FANNIN ST
Provider Second Line Business Practice Location Address:
SUITE 660
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-822-3106
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/04/2008

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: 207X00000X , with the licence number:  P-236524 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XP3100X , with the licence number: 248268 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XS0114X , with the licence number: 248268 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X , with the licence number: 248268 , 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: D72407 . This is a "LICENSE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".