1871024638 NPI number — CAROLINE ELIZABETH MULLIS M.D.

Table of content: CAROLINE ELIZABETH MULLIS M.D. (NPI 1871024638)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871024638 NPI number — CAROLINE ELIZABETH MULLIS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MULLIS
Provider First Name:
CAROLINE
Provider Middle Name:
ELIZABETH
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:
1871024638
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/11/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 E 210TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRONX
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10467-2401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-920-4622
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17 E 102ND ST
Provider Second Line Business Practice Location Address:
CENTER FOR ADVANCED MEDICINE
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10029-5204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-659-8551
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/23/2017

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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