1821108804 NPI number — EMPIRE MEDICAL GROUP OF NEW YORK PC

Table of content: (NPI 1821108804)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821108804 NPI number — EMPIRE MEDICAL GROUP OF NEW YORK PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMPIRE MEDICAL GROUP OF NEW YORK 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:
1821108804
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 LANIDEX PLAZA
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
PARSIPPANY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07054
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-544-3066
Provider Business Mailing Address Fax Number:
718-544-3125

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
113-02 QUEENS BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOREST HILLS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11375
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-544-3066
Provider Business Practice Location Address Fax Number:
718-544-3125
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BURNS
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
TIMOTHY
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
212-818-1555

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 07407 . This is a "GHI MEDICARE PROVIDER ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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