1437697117 NPI number — MERCY DRIVE REGIONAL

Table of content: DR. NICHOLAS DANE IVES DMD (NPI 1528027851)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437697117 NPI number — MERCY DRIVE REGIONAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERCY DRIVE REGIONAL
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:
1437697117
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/02/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7235 112TH ST # SST
Provider Second Line Business Mailing Address:
PR-6
Provider Business Mailing Address City Name:
FOREST HILLS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11375-5469
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-725-9896
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7235 112TH ST # SST
Provider Second Line Business Practice Location Address:
PR-6
Provider Business Practice Location Address City Name:
FOREST HILLS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11375-5469
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-725-9896
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/02/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
COCHRAN
Authorized Official First Name:
CHRISTABELLA
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
718-725-9896

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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