1598915027 NPI number — COLUMBIA DENTAL SERVICES

Table of content: (NPI 1598915027)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598915027 NPI number — COLUMBIA DENTAL SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLUMBIA DENTAL SERVICES
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:
DR. FALGUNI PATEL DENTAL PLLC
Provider Other Organization Name Type Code:
5
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:
1598915027
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
563 W 169TH ST
Provider Second Line Business Mailing Address:
SUITE NUMBER 100
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10032-3912
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-923-3375
Provider Business Mailing Address Fax Number:
646-253-1270

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
563 W 169TH ST
Provider Second Line Business Practice Location Address:
SUITE NUMBER 100
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10032-3912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-923-3375
Provider Business Practice Location Address Fax Number:
646-253-1270
Provider Enumeration Date:
09/20/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PATEL
Authorized Official First Name:
FALGUNI
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
212-923-3375

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  050260 , 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: 02325868 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 16356 . This is a "DORAL" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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