1891968012 NPI number — MAILIN MIMI LAI, D.D.S., P.C.

Table of content: (NPI 1891968012)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891968012 NPI number — MAILIN MIMI LAI, D.D.S., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAILIN MIMI LAI, D.D.S., P.C.
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:
1891968012
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/19/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11 E BROADWAY
Provider Second Line Business Mailing Address:
13TH FLOOR
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10038-1013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-227-3088
Provider Business Mailing Address Fax Number:
212-227-3866

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11 E BROADWAY
Provider Second Line Business Practice Location Address:
13TH FLOOR
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10038-1013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-227-3088
Provider Business Practice Location Address Fax Number:
212-227-3866
Provider Enumeration Date:
04/09/2008

Additional Information

Authorized Official

Authorized Official Last Name:
LAI
Authorized Official First Name:
MAILIN
Authorized Official Middle Name:
MIMI
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
212-227-3088

Provider Taxonomy Codes

  • Taxonomy code: 122300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 02635110 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 03047812 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 03822200 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02883778 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02587759 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 03072566 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 013560506 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010911258 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02756389 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02901664 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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