1508920521 NPI number — NEW YORK INSTITUTE OF SAME DAY SURGERY

Table of content: (NPI 1508920521)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508920521 NPI number — NEW YORK INSTITUTE OF SAME DAY SURGERY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW YORK INSTITUTE OF SAME DAY SURGERY
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:
1508920521
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
99 DUTCH HILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORANGEBURG
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10962-2106
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-359-9000
Provider Business Mailing Address Fax Number:
845-359-0729

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
99 DUTCH HILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORANGEBURG
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10962-2106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-359-9000
Provider Business Practice Location Address Fax Number:
845-359-0729
Provider Enumeration Date:
12/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MATTA
Authorized Official First Name:
AYMAN
Authorized Official Middle Name:
Z.
Authorized Official Title or Position:
DELEGATED OFFICIAL
Authorized Official Telephone Number:
845-359-9000

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  215965-1 , 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: IC0716 . This is a "HEALTHNET #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0051708 . This is a "AETNA HMO#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: A448704 . This is a "OXFORD#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 003621 . This is a "EMPIRE BCBS#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01241923 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8457010 . This is a "AETNA PPO#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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