1811983489 NPI number — ROBY ADHINAYAK LAL DO

Table of content: (NPI 1417333949)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811983489 NPI number — ROBY ADHINAYAK LAL DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAL
Provider First Name:
ROBY
Provider Middle Name:
ADHINAYAK
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LAL
Provider Other First Name:
ADHINAYAK
Provider Other Middle Name:
ROBY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DO
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1811983489
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/24/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
221 NE GLEN OAK AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEORIA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61636-0002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
309-672-5702
Provider Business Mailing Address Fax Number:
309-671-2774

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
221 NE GLEN OAK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEORIA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61636-0002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-672-5702
Provider Business Practice Location Address Fax Number:
309-671-2774
Provider Enumeration Date:
09/20/2005

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: 2085R0001X , with the licence number:  OS007227L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0001X , with the licence number: 036-116007 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0361160072 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: CM5868 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 001522959 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00334468 . This is a "RAILROAD MEDICARE PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00609726 . This is a "RAILROAD MEDICARE PART B PTAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 014885 . This is a "HEALTH ALLIANCE INS." identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com