1578753554 NPI number — NEW YORK COLORECTAL CARE LLC

Table of content: (NPI 1578753554)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578753554 NPI number — NEW YORK COLORECTAL CARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW YORK COLORECTAL CARE 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:
1578753554
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
133 EAST 58TH STREET
Provider Second Line Business Mailing Address:
#304
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-688-2100
Provider Business Mailing Address Fax Number:
212-688-2136

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
133 EAST 58TH STREET
Provider Second Line Business Practice Location Address:
#304
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-688-2100
Provider Business Practice Location Address Fax Number:
212-688-2136
Provider Enumeration Date:
07/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KAFKA
Authorized Official First Name:
NICOLE
Authorized Official Middle Name:
J
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
212-688-2100

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X , with the licence number:  1811531 , 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: 1886829 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1578753554 . This is a "NPI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000282 . This is a "EMPIRE BLUECROSS BLUESHIE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5291622 . This is a "AETNA PPO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2004177 . This is a "AETNA MEDICARE HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P887209 . This is a "OXFORD HEALTH PLANS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 4699994 . This is a "GHI PPO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P00000021264 . This is a "GHI MEDICARE HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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