1669511275 NPI number — DAVID L PODELL JR. M.D.

Table of content: DAVID L PODELL JR. M.D. (NPI 1669511275)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669511275 NPI number — DAVID L PODELL JR. M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PODELL
Provider First Name:
DAVID
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
JR.
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1669511275
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
67 E 78TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10021-0204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-628-2323
Provider Business Mailing Address Fax Number:
212-570-9849

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
67 E 78TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10021-0204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-628-2323
Provider Business Practice Location Address Fax Number:
212-570-9849
Provider Enumeration Date:
02/06/2007

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: 207W00000X , with the licence number:  086959 , 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: 0076870 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 46610P . This is a "H.I.P." identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P378216 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 168481 . This is a "EMPIRE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00135846 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0C0114 . This is a "PHS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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