1487615944 NPI number — MR. MICHAEL E KOETTING LCSW

Table of content: MR. MICHAEL E KOETTING LCSW (NPI 1487615944)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487615944 NPI number — MR. MICHAEL E KOETTING LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOETTING
Provider First Name:
MICHAEL
Provider Middle Name:
E
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
M

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:
1487615944
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 W 64TH ST
Provider Second Line Business Mailing Address:
SUITE 11D
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10023-6734
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-877-6523
Provider Business Mailing Address Fax Number:
212-741-2606

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
49 W 24TH ST
Provider Second Line Business Practice Location Address:
SUITE 906
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10010-3206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-741-2606
Provider Business Practice Location Address Fax Number:
212-741-2606
Provider Enumeration Date:
03/31/2006

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: 1041C0700X , with the licence number:  R049450 , 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: N1H95 . This is a "EMPIRE BLUE CROSS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P1316096 . This is a "OXFORD HEALTH PLANS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01947786 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 337512 . This is a "VALUE OPTIONS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7407501 . This is a "GROUP HEALTH INCORPORATED" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: KM9450 . This is a "ATLANTIS HEALTH PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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