1538452867 NPI number — WILLIAM A HEALY III MD PC

Table of content: (NPI 1538452867)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538452867 NPI number — WILLIAM A HEALY III MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLIAM A HEALY III MD 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:
1538452867
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
196 E MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTINGTON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11743-2922
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-271-8030
Provider Business Mailing Address Fax Number:
631-271-8448

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
196 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTINGTON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11743-2922
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-271-8030
Provider Business Practice Location Address Fax Number:
631-271-8448
Provider Enumeration Date:
05/19/2011

Additional Information

Authorized Official

Authorized Official Last Name:
HEALY
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
631-271-8030

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  198084 , 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: 73G801 . This is a "EMPIRE BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1455384 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P683881 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1C2414 . This is a "HEALTHNET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7826 . This is a "AFFINITY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 4225030 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: M7698P . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 13417 . This is a "VYTRA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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