1578678330 NPI number — VIRNA LISI-DEMARTINO MD

Table of content: VIRNA LISI-DEMARTINO MD (NPI 1578678330)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578678330 NPI number — VIRNA LISI-DEMARTINO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LISI-DEMARTINO
Provider First Name:
VIRNA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1578678330
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/11/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 S BEDFORD RD
Provider Second Line Business Mailing Address:
CARE MOUNT MEDICAL PC
Provider Business Mailing Address City Name:
MOUNT KISCO
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10549-3446
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-241-1050
Provider Business Mailing Address Fax Number:
914-242-1516

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
90 S BEDFORD RD
Provider Second Line Business Practice Location Address:
CARE MOUNT MEDICAL PC
Provider Business Practice Location Address City Name:
MOUNT KISCO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10549-3412
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-241-1050
Provider Business Practice Location Address Fax Number:
914-242-1516
Provider Enumeration Date:
08/20/2006

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: 2085R0202X , with the licence number:  226804 , 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: 02804135 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com