1932374600 NPI number — MARGARITA R DE FEDERICIS MD

Table of content: MARGARITA R DE FEDERICIS MD (NPI 1932374600)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932374600 NPI number — MARGARITA R DE FEDERICIS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DE FEDERICIS
Provider First Name:
MARGARITA
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MOSQUERA
Provider Other First Name:
MARGARITA
Provider Other Middle Name:
ROSA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1932374600
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/04/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9 CAREY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
QUEENSBURY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12804-7880
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-761-0300
Provider Business Mailing Address Fax Number:
518-824-2388

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1299 ROUTE 9
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GANSEVOORT
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12831-1560
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-761-6961
Provider Business Practice Location Address Fax Number:
518-761-1006
Provider Enumeration Date:
04/24/2008

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: 207Q00000X , with the licence number:  266741 , 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)

  • Identifier: 03523246 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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