1407068711 NPI number — MR. NOAH BENJAMIN CLYMAN LCSW, ACT

Table of content: MR. NOAH BENJAMIN CLYMAN LCSW, ACT (NPI 1407068711)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407068711 NPI number — MR. NOAH BENJAMIN CLYMAN LCSW, ACT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CLYMAN
Provider First Name:
NOAH
Provider Middle Name:
BENJAMIN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LCSW, ACT
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:
1407068711
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/06/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3414 81ST ST
Provider Second Line Business Mailing Address:
APT. 2
Provider Business Mailing Address City Name:
JACKSON HEIGHTS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11372-2817
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-768-7552
Provider Business Mailing Address Fax Number:
347-730-5535

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19 W 34TH ST
Provider Second Line Business Practice Location Address:
PENTHOUSE
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10001-3006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-768-7552
Provider Business Practice Location Address Fax Number:
347-730-5535
Provider Enumeration Date:
05/07/2007

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: 1041C0700X , with the licence number:  078302-1 , 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)





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