1912216060 NPI number — DR. NOBLE ASHWORTH ENDICOTT JR. MD

Table of content: DR. NOBLE ASHWORTH ENDICOTT JR. MD (NPI 1912216060)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912216060 NPI number — DR. NOBLE ASHWORTH ENDICOTT JR. MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ENDICOTT
Provider First Name:
NOBLE
Provider Middle Name:
ASHWORTH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1912216060
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/06/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 W 246TH ST.
Provider Second Line Business Mailing Address:
(APT 1203)
Provider Business Mailing Address City Name:
BRONX
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10471
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-884-5012
Provider Business Mailing Address Fax Number:
212-543-5386

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 W 246TH ST.
Provider Second Line Business Practice Location Address:
(APT 1203)
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10471
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-884-5012
Provider Business Practice Location Address Fax Number:
212-543-5386
Provider Enumeration Date:
10/06/2010

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: 2084P0800X , with the licence number:  082596 , 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)





Copyright © 2007-2025 www.npivalidator.com