1598794430 NPI number — METROPOLITAN LITHOTRIPTOR ASSOCIATES, PC

Table of content: (NPI 1598794430)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598794430 NPI number — METROPOLITAN LITHOTRIPTOR ASSOCIATES, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
METROPOLITAN LITHOTRIPTOR ASSOCIATES, 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:
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:
1598794430
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/14/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
205 LEXINGTON AVENUE
Provider Second Line Business Mailing Address:
FLOOR 15
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
646-742-8800
Provider Business Mailing Address Fax Number:
646-742-8850

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
176-60 UNION TURNPIKE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
FRESH MEADOWS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11366
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
646-742-8800
Provider Business Practice Location Address Fax Number:
646-742-8850
Provider Enumeration Date:
07/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PAVLICA
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE VP
Authorized Official Telephone Number:
646-742-8802

Provider Taxonomy Codes

  • Taxonomy code: 208800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: ANC144 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: IC7854 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 293999 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 346777374 . This is a "VYTRA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 97003 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: AZ00256 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1000332 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8459536 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 001151 . This is a "HORIZON" identifier . This identifiers is of the category "OTHER".




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