1821376005 NPI number — OMNICARE MULTI SPECIALTY CENTER, LLC

Table of content: (NPI 1821376005)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821376005 NPI number — OMNICARE MULTI SPECIALTY CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OMNICARE MULTI SPECIALTY CENTER, LLC
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:
OMNICARE ANESTHESIA, P.C.
Provider Other Organization Name Type Code:
3
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:
1821376005
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/02/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
763-765 NOSTRAND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11216-4203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-774-0171
Provider Business Mailing Address Fax Number:
718-773-7470

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
763-765 NOSTRAND AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-774-0171
Provider Business Practice Location Address Fax Number:
718-773-7470
Provider Enumeration Date:
07/22/2011

Additional Information

Authorized Official

Authorized Official Last Name:
SERRANO
Authorized Official First Name:
REGINE
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING MANAGER
Authorized Official Telephone Number:
718-774-0171

Provider Taxonomy Codes

  • Taxonomy code: 172V00000X , with the licence number:  177953 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , with the licence number: 177953 , 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)





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