1598824294 NPI number — MARIE ANGELLA REID DURANT MD

Table of content: MARIE ANGELLA REID DURANT MD (NPI 1598824294)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598824294 NPI number — MARIE ANGELLA REID DURANT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REID DURANT
Provider First Name:
MARIE
Provider Middle Name:
ANGELLA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
REID
Provider Other First Name:
MARIE
Provider Other Middle Name:
ANGELLA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1598824294
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
451 CLARKSON AVE
Provider Second Line Business Mailing Address:
E BUILDING
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11203-2057
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-245-3200
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
451 CLARKSON AVE
Provider Second Line Business Practice Location Address:
E BUILDING
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11203-2057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-245-3200
Provider Business Practice Location Address Fax Number:
718-245-5560
Provider Enumeration Date:
12/08/2006

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: 207RG0300X , with the licence number:  208963 , 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)





Copyright © 2007-2024 www.npivalidator.com