1568485985 NPI number — GRAND STREET MEDICAL PLLC

Table of content: MRS. BRITTANY JOHNSON TODD MAED, NCC, LPCA (NPI 1013482025)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568485985 NPI number — GRAND STREET MEDICAL PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRAND STREET MEDICAL PLLC
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:
6
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:
1568485985
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/18/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
80 E END AVE
Provider Second Line Business Mailing Address:
14-B
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10028-8004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-734-9031
Provider Business Mailing Address Fax Number:
212-794-2441

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
666 GRAND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11211-4853
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-963-0555
Provider Business Practice Location Address Fax Number:
718-963-4889
Provider Enumeration Date:
07/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GANDHI
Authorized Official First Name:
HEMA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
ADMINISTRATION
Authorized Official Telephone Number:
718-782-4768

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  111281 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 111281 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0300X , with the licence number: 111281 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208100000X , with the licence number: 111281 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: 111281 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207QA0401X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207QG0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RX0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X , with the licence number: 111281 , 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: GJ617239 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0192659 . This is a "GRAND STREET MEDICAL PC" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 12295130 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 55247 . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00199748 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 11128160NY . This is a "1199 NATIONAL BENEFIT" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: WPPD41 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 03196274 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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