1538411996 NPI number — MS. BEVERLY A. COLON PA

Table of content: MS. BEVERLY A. COLON PA (NPI 1538411996)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538411996 NPI number — MS. BEVERLY A. COLON PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLON
Provider First Name:
BEVERLY
Provider Middle Name:
A.
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
F

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:
1538411996
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
150 EAST 45TH STREET SUITE 227
Provider Second Line Business Mailing Address:
CHILDREN'S AID SOCIETY
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10017-3192
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-949-4958
Provider Business Mailing Address Fax Number:
212-682-2613

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
150 EAST 45TH STREET
Provider Second Line Business Practice Location Address:
LORD MEMORIAL CLINIC
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10017-3192
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-949-4958
Provider Business Practice Location Address Fax Number:
212-682-2613
Provider Enumeration Date:
10/10/2012

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: 363A00000X , with the licence number:  000296-1 , 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: 00245423 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com