1750366449 NPI number — DR. PERICLES S HADJIYANE M.D.

Table of content: DR. PERICLES S HADJIYANE M.D. (NPI 1750366449)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750366449 NPI number — DR. PERICLES S HADJIYANE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HADJIYANE
Provider First Name:
PERICLES
Provider Middle Name:
S
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
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:
1750366449
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/07/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7475
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WANTAGH
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11793-0475
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-728-1771
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
375 E BAY DR
Provider Second Line Business Practice Location Address:
KOMANOFF CENTER FOR GERIATRIC REHAB
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11561-2350
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-728-1771
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/14/2005

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: 208100000X , with the licence number:  198348 , 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: NS0003581 . This is a "SELECT PRO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 198348 . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6358058002 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 67349 . This is a "VYTRA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2C8868 . This is a "HEALTHNET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P1537305 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: CPMR1298348-5 . This is a "WC, NO FAULT" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01755215 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 11051997 . This is a "MULTIPLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 112573413 . This is a "CNN,HUMN,GAL,HORZ,MAGN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2799832 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 130021357 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 112573413 . This is a "NGS,OHP,GRTWEST,PHCS,UHC," identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 83Y511 . This is a "BC BS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 970401 . This is a "HEALTHCARE PARTNERS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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