1811047616 NPI number — NY NEUROSCIENCE ASSOCIATE, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811047616 NPI number — NY NEUROSCIENCE ASSOCIATE, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NY NEUROSCIENCE ASSOCIATE, 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:
1811047616
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
210 LAFAYETTE ST APT 10A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10012-4018
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-746-2396
Provider Business Mailing Address Fax Number:
212-772-0357

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
JAMAICA HOSPITAL 8900 VAN WYCK EXPRESSWAY, JAMAICA, NY
Provider Second Line Business Practice Location Address:
NEW YORK PRESBYTERIAN HOSPITAL 525 EAST 68TH STREET
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-746-2396
Provider Business Practice Location Address Fax Number:
212-772-0357
Provider Enumeration Date:
01/12/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GHAJAR
Authorized Official First Name:
JAMSHID
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
212-746-2396

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01033738 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".