1912180316 NPI number — SPANISH SPEAKING ELDERLY COUNCIL- RAICES

Table of content: DR. ABRAHAM AVI NISIM MD (NPI 1639306392)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912180316 NPI number — SPANISH SPEAKING ELDERLY COUNCIL- RAICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPANISH SPEAKING ELDERLY COUNCIL- RAICES
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:
1912180316
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/10/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
51 TULIP ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BERGENFIELD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07621-3816
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-338-2053
Provider Business Mailing Address Fax Number:
718-222-4376

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 HANOVER PL PH
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:
11201-5840
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-222-1518
Provider Business Practice Location Address Fax Number:
718-222-4376
Provider Enumeration Date:
12/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SOSA-DICKSON
Authorized Official First Name:
LISETTE
Authorized Official Middle Name:
Authorized Official Title or Position:
CLINICAL DIRECTOR
Authorized Official Telephone Number:
718-222-1518

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  067580 , 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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