1447581079 NPI number — RIVER PARK FAMILY MEDICINE, PC

Table of content: MRS. COMEL JOYCE BELIN M.ED., MBA (NPI 1437308434)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447581079 NPI number — RIVER PARK FAMILY MEDICINE, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RIVER PARK FAMILY MEDICINE, 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:
1447581079
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/21/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
908 NIAGARA FALLS BLVD
Provider Second Line Business Mailing Address:
SUITE 208
Provider Business Mailing Address City Name:
NORTH TONAWANDA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14120-2019
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-692-3302
Provider Business Mailing Address Fax Number:
716-692-4342

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 HOSPITAL DR
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
MASSENA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13662-1037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-764-1447
Provider Business Practice Location Address Fax Number:
315-764-1447
Provider Enumeration Date:
01/21/2010

Additional Information

Authorized Official

Authorized Official Last Name:
LOGALBO
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
Authorized Official Title or Position:
DO/OWNER
Authorized Official Telephone Number:
315-764-1447

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  188335 , 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: 02632048 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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