1750323010 NPI number — SHIVENDER K THAKUR

Table of content: SHIVENDER K THAKUR (NPI 1750323010)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750323010 NPI number — SHIVENDER K THAKUR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THAKUR
Provider First Name:
SHIVENDER
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1750323010
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
890 WESTFALL RD
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14618-2610
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-442-6960
Provider Business Mailing Address Fax Number:
585-442-3548

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
890 WESTFALL RD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14618-2610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-442-6960
Provider Business Practice Location Address Fax Number:
585-442-3548
Provider Enumeration Date:
06/12/2006

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: 207R00000X , with the licence number:  192844 , 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: 00027284401 . This is a "UNIVERA #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 050906000002 . This is a "FIDELIS CARE #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 192844-9W . This is a "WORKERS COMP #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0491669 . This is a "IHA #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P010192844 . This is a "BLUE CHOICE #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 101474BJ . This is a "PREFERRED CARE #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com