1417122888 NPI number — DOMINICK SERVEDIO, AU.D, P.C.

Table of content: (NPI 1417122888)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417122888 NPI number — DOMINICK SERVEDIO, AU.D, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOMINICK SERVEDIO, AU.D, P.C.
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:
1417122888
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:
200 W 57TH ST
Provider Second Line Business Mailing Address:
SUITE 910
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10019-3211
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-441-6094
Provider Business Mailing Address Fax Number:
917-441-6102

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 W 57TH ST
Provider Second Line Business Practice Location Address:
SUITE 910
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10019-3211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-441-6094
Provider Business Practice Location Address Fax Number:
917-441-6102
Provider Enumeration Date:
04/28/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SERVEDIO
Authorized Official First Name:
DOMINICK
Authorized Official Middle Name:
Authorized Official Title or Position:
AUDIOLOGIST/ OWNER
Authorized Official Telephone Number:
917-441-6094

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  1080 , 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: M75911 . This is a "EMPIRE BLUE CROSS BLUE SHEILD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 241110 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P12043249 . This is a "MULTIPLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 174255 . This is a "ELDERPLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5C6011 . This is a "HEALTHNET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7103327 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: SD1080 . This is a "ATLANTIS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P3028736 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 160570P . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1000048259 . This is a "AFFINITY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 4899667 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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