1427267889 NPI number — LORRAINE CHRISOMALIS VALASIADIS MD

Table of content: LORRAINE CHRISOMALIS VALASIADIS MD (NPI 1427267889)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427267889 NPI number — LORRAINE CHRISOMALIS VALASIADIS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHRISOMALIS VALASIADIS
Provider First Name:
LORRAINE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHRISOMALIS
Provider Other First Name:
LORRAINE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1427267889
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500A E 87TH ST
Provider Second Line Business Mailing Address:
1ST FLOOR
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10128-7650
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-879-7180
Provider Business Mailing Address Fax Number:
212-879-7181

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500A E 87TH ST
Provider Second Line Business Practice Location Address:
1ST FLOOR
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10128-7650
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-879-7180
Provider Business Practice Location Address Fax Number:
212-879-7181
Provider Enumeration Date:
05/22/2007

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: 207VX0000X , with the licence number:  188898 , 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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