1801952981 NPI number — LOBINA KANIZ KALAM M.D.

Table of content: LOBINA KANIZ KALAM M.D. (NPI 1801952981)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801952981 NPI number — LOBINA KANIZ KALAM M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KALAM
Provider First Name:
LOBINA
Provider Middle Name:
KANIZ
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1801952981
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/28/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
55 WATER ST
Provider Second Line Business Mailing Address:
FL 12
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10041-0004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-633-8255
Provider Business Mailing Address Fax Number:
929-263-3957

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1250 WATERS PL
Provider Second Line Business Practice Location Address:
TOWER 2 11TH FLOOR
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10461-2720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-633-8255
Provider Business Practice Location Address Fax Number:
929-263-3957
Provider Enumeration Date:
12/31/2006

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:  230905 , 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: 2828715 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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