1508959917 NPI number — RYE BROOK NEUROLOGY, PC

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508959917 NPI number — RYE BROOK NEUROLOGY, PC

Employer Identification Number (EIN):

Provider Organization Name:

RYE BROOK NEUROLOGY, 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 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:

1508959917

Entity Type Code:

Organization

Replacement NPI:

Last Update Date:

04/18/2008

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

153 E 87TH ST APT 10B

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:

10128-2708

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

77 QUAKER RIDGE RD

Provider Second Line Business Practice Location Address:

STE 207

Provider Business Practice Location Address City Name:

NEW ROCHELLE

Provider Business Practice Location Address State Name:

NY

Provider Business Practice Location Address Postal Code:

10804-2808

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

917-272-2680

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

09/30/2006

Authorized Official Last Name:

DE JESUS

Authorized Official First Name:

MARIA

Authorized Official Middle Name:

AUDRIE

Authorized Official Title or Position:

PRESIDENT/ OWNER

Authorized Official Telephone Number:

212-255-2333

• Taxonomy code: 207T00000X , with the licence number:  206602 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 30440476 . This is a "MAGNACARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 7745380 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: DM6602 . This is a "ATLANTIS HEALTH PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 2399196 . This is a "UHC" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 7051585 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: P3241805 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 206602 . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 01872586 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
• Identifier: 4C9461 . This is a "HEALTH NET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 53N521 . This is a "EMPIRE BCBS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 030440476DE02 . This is a "CARE PLUS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 3099038 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".