1558344242 NPI number — DIANE ORLOV N.P.

Table of content: DIANE ORLOV N.P. (NPI 1558344242)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558344242 NPI number — DIANE ORLOV N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ORLOV
Provider First Name:
DIANE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
N.P.
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:
1558344242
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/16/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6101 LAKE ELLENOR DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32809-4616
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-723-5029
Provider Business Mailing Address Fax Number:
407-858-5523

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
832 W CENTRAL BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32805-1809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-723-4239
Provider Business Practice Location Address Fax Number:
407-845-6119
Provider Enumeration Date:
11/28/2005

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: 363L00000X , with the licence number:  RN-241877 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X , with the licence number: APRN9490972 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 104216600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2034444 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: JSJEO . This is a "FL BLUE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 104216600 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com