1598771305 NPI number — EILEEN MARGARET JANEC M.D.

Table of content: EILEEN MARGARET JANEC M.D. (NPI 1598771305)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598771305 NPI number — EILEEN MARGARET JANEC M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JANEC
Provider First Name:
EILEEN
Provider Middle Name:
MARGARET
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1598771305
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/01/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
210 WESTCHESTER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHITE PLAINS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10604-2901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-682-6466
Provider Business Mailing Address Fax Number:
914-681-5222

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 BROADWAY
Provider Second Line Business Practice Location Address:
2ND FL
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10006-1901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-263-9700
Provider Business Practice Location Address Fax Number:
212-263-9701
Provider Enumeration Date:
08/01/2006

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: 207RG0100X , with the licence number:  13014 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1012416 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30205906 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".




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