1801934526 NPI number — HAROLD S ROSS MD PC

Table of content: (NPI 1801934526)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801934526 NPI number — HAROLD S ROSS MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAROLD S ROSS MD PC
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:
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:
1801934526
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
738 PRE EMPTION RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GENEVA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14456-1336
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-789-4922
Provider Business Mailing Address Fax Number:
315-789-1791

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
738 PRE EMPTION RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GENEVA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14456-1336
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-789-4922
Provider Business Practice Location Address Fax Number:
315-789-1791
Provider Enumeration Date:
02/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ROSS
Authorized Official First Name:
HAROLD
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
315-789-4922

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X , with the licence number:  127211 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QS0132X , with the licence number: 127211 , 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: 0802 . This is a "EXCELLUS BC BS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7701336 . This is a "DOCTORS HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100751CR . This is a "PREFERRED CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7320096 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0802 . This is a "HEALTHY NY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7701336 . This is a "MVP SELECT CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000912620001 . This is a "HEALTH NOW" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00460022 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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