1407932684 NPI number — BAY SHORE OB GYN GROUP PC

Table of content: (NPI 1407932684)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407932684 NPI number — BAY SHORE OB GYN GROUP PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAY SHORE OB GYN GROUP 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:
1407932684
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
41 BRENTWOOD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAY SHORE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11706-6923
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-665-0808
Provider Business Mailing Address Fax Number:
631-665-0816

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
41 BRENTWOOD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAY SHORE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11706-6923
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-665-0808
Provider Business Practice Location Address Fax Number:
631-665-0816
Provider Enumeration Date:
10/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LIPARI
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
JOHN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
631-665-0808

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  136230 , 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: 70836 . This is a "USHC AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: AG45807 . This is a "MDNY" identifier . This identifiers is of the category "OTHER".
  • Identifier: PM9116 . This is a "BC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4217872 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 49221 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0059757 11068BS . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 14454 . This is a "VYTRA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00642764 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2154 . This is a "MAGNAHEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: PM9116 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com