1508227265 NPI number — WALTER VERNON

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 1508227265 NPI number — WALTER VERNON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VERNON
Provider First Name:
WALTER
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VERNON
Provider Other First Name:
WALTER
Provider Other Middle Name:
HUDSON
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1508227265
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/09/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
435 WEBSTER AVE APT 6PH
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW ROCHELLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-884-2992
Provider Business Mailing Address Fax Number:
718-884-2901

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
435 WEBSTER AVE APT 6PH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW ROCHELLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-884-2992
Provider Business Practice Location Address Fax Number:
718-884-2901
Provider Enumeration Date:
03/09/2016

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: 101YM0800X , with the licence number:  NYCPS-P388 , 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: 131930700 . This is a "RIVERDALE MENTAL HEALTH ASSOCIATION" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com