1760461768 NPI number — DR. IOSIF KOLBOVSKY MD

Table of content: DR. IOSIF KOLBOVSKY MD (NPI 1760461768)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760461768 NPI number — DR. IOSIF KOLBOVSKY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOLBOVSKY
Provider First Name:
IOSIF
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1760461768
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
210 WESTCHESTER AVE
Provider Second Line Business Mailing Address:
3RD FLOOR
Provider Business Mailing Address City Name:
WHITE PLAINS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10604-2901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-681-3146
Provider Business Mailing Address Fax Number:
914-682-6403

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
222 WESTCHESTER AVE
Provider Second Line Business Practice Location Address:
SUITE 405
Provider Business Practice Location Address City Name:
WHITE PLAINS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10604-2906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-683-6474
Provider Business Practice Location Address Fax Number:
914-682-6403
Provider Enumeration Date:
01/10/2006

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: 207RN0300X , with the licence number:  455919-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RN0300X , with the licence number: 042936 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 133884168 . This is a "PHCS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0005947624 . This is a "AETNA (NON HMO)" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 173AU1/173AU2 . This is a "BLUE CROSS ALL PLANS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 3399522 . This is a "GHI PPO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P670485 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1829646 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01695629/0233897 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 133884168 . This is a "EMPIR STATE PLAN (NYS)" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 133884168 . This is a "POMCO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000077243 . This is a "GHI HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0D2976 . This is a "HEALTH NET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 133884168 . This is a "BEECH STREET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 133884168 . This is a "CIGNA SPECIALTY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 133884168 . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 133884168 . This is a "MULTIPLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 3375645 . This is a "AENTAN HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 002989 . This is a "CONNECTICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 133884168 . This is a "HORIZON HEALTHCARE OF NY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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