1578779302 NPI number — EXECUTIVE HEALTH MEDICAL GROUP OF NEW YORK, PC

Table of content: DR. FREDERICK KRISTIAN STORM III M.D. (NPI 1669614798)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578779302 NPI number — EXECUTIVE HEALTH MEDICAL GROUP OF NEW YORK, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EXECUTIVE HEALTH MEDICAL GROUP OF NEW YORK, PC
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:
EXECUTIVE HEALTH EXAMS
Provider Other Organization Name Type Code:
3
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:
1578779302
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 ROCKEFELLER PLZ
Provider Second Line Business Mailing Address:
4TH FLOOR
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10020-1903
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-332-3700
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 ROCKEFELLER PLZ
Provider Second Line Business Practice Location Address:
4TH FLOOR
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10020-1903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-332-3700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GUZMAN
Authorized Official First Name:
ROXANA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF ACCOUNTING
Authorized Official Telephone Number:
212-332-3725

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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