1427512623 NPI number — CERRI & DROZ MEDICAL GROUP,LLC

Table of content: (NPI 1427512623)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427512623 NPI number — CERRI & DROZ MEDICAL GROUP,LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CERRI & DROZ MEDICAL GROUP,LLC
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:
1427512623
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/22/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24175A OAK PARK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOUGLASTON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11362
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-210-4255
Provider Business Mailing Address Fax Number:
516-945-0887

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2818 STEINWAY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASTORIA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11103-3349
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-210-4255
Provider Business Practice Location Address Fax Number:
516-945-0887
Provider Enumeration Date:
01/22/2019

Additional Information

Authorized Official

Authorized Official Last Name:
CERRI
Authorized Official First Name:
RUBEN
Authorized Official Middle Name:
WALTER
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
718-210-4255

Provider Taxonomy Codes

  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084P0804X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





Copyright © 2007-2024 www.npivalidator.com