1497121271 NPI number — NUNZIO SIGNORELLA, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497121271 NPI number — NUNZIO SIGNORELLA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NUNZIO SIGNORELLA, 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:
1497121271
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/17/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
159 MADISON AVE, 3I
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10016-5434
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
347-675-9873
Provider Business Mailing Address Fax Number:
646-707-0109

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
80 E. 11TH STREET
Provider Second Line Business Practice Location Address:
610
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10003-6819
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-675-9873
Provider Business Practice Location Address Fax Number:
646-707-0109
Provider Enumeration Date:
08/17/2015

Additional Information

Authorized Official

Authorized Official Last Name:
SIGNORELLA
Authorized Official First Name:
NUNZIO
Authorized Official Middle Name:
Authorized Official Title or Position:
PRINCIPAL
Authorized Official Telephone Number:
347-675-9873

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X , 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: 02542107 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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