1508914367 NPI number — INTERNAL MEDICINE ASSOCIATES OF STATESBORO II, PC

Table of content: DR. MARC NEIL RUBINSTEIN D.D.S. (NPI 1881704666)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508914367 NPI number — INTERNAL MEDICINE ASSOCIATES OF STATESBORO II, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTERNAL MEDICINE ASSOCIATES OF STATESBORO II, 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:
1508914367
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/27/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1601 FAIR ROAD
Provider Second Line Business Mailing Address:
SUITE 700
Provider Business Mailing Address City Name:
STATESBORO
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30458-0800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-681-8488
Provider Business Mailing Address Fax Number:
912-681-4337

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1601 FAIR RD
Provider Second Line Business Practice Location Address:
SUITE 700
Provider Business Practice Location Address City Name:
STATESBORO
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30458-1698
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-681-8488
Provider Business Practice Location Address Fax Number:
912-681-4337
Provider Enumeration Date:
01/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DALSANIA
Authorized Official First Name:
SARAJU
Authorized Official Middle Name:
C
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
912-681-8488

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  045196 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 602993737A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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