1548340532 NPI number — DECO ASSOCIATES, LLC

Table of content: (NPI 1548340532)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548340532 NPI number — DECO ASSOCIATES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DECO ASSOCIATES, LLC
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:
1548340532
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3141 RTE 9W
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
NEW WINDSOR
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12553-6710
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-294-4208
Provider Business Mailing Address Fax Number:
845-294-0773

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3141 RTE 9W
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
NEW WINDSOR
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12553-6710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-294-4208
Provider Business Practice Location Address Fax Number:
845-294-0773
Provider Enumeration Date:
10/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COONS
Authorized Official First Name:
DONALD
Authorized Official Middle Name:
F
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
845-294-4208

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 335E00000X , with the licence number: 1548340532 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 004177821 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02832626 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com