1588651079 NPI number — BOSTON CHILDRENS HEALTH PHYSICIANS LLP

Table of content: (NPI 1588651079)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588651079 NPI number — BOSTON CHILDRENS HEALTH PHYSICIANS LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BOSTON CHILDRENS HEALTH PHYSICIANS LLP
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:
BOSTON CHILDRENS HEALTH PHYSICIANS PEDIATRIC ENDOCRINOLOGY DIVISION
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:
1588651079
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
40 SUNSHINE COTTAGE RD # 1N-C08
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VALHALLA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10595-1524
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-593-1659
Provider Business Mailing Address Fax Number:
914-593-1790

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
755 N BROADWAY STE 400
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SLEEPY HOLLOW
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10591
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-366-3400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
NEWMAN
Authorized Official First Name:
LEONARD
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
914-594-4280

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , 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: 33D0681397 . This is a "CLIA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02729519 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com