1407133150 NPI number — EAST COAST FERTILITY, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407133150 NPI number — EAST COAST FERTILITY, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAST COAST FERTILITY, PC
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:
1407133150
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/09/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
245 NEWTOWN RD
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
PLAINVIEW
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11803-4316
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-939-6695
Provider Business Mailing Address Fax Number:
516-501-6934

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2500 NESCONSET HIGHWAY
Provider Second Line Business Practice Location Address:
BUILDING 19, SUITE 70
Provider Business Practice Location Address City Name:
STONYBROOK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11790
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-939-6695
Provider Business Practice Location Address Fax Number:
516-501-6934
Provider Enumeration Date:
11/09/2011

Additional Information

Authorized Official

Authorized Official Last Name:
TODARO
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
516-939-6695

Provider Taxonomy Codes

  • Taxonomy code: 207VE0102X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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