1942511183 NPI number — STEPHEN DELLA CROCE MS, RD, CDN

Table of content: STEPHEN DELLA CROCE MS, RD, CDN (NPI 1942511183)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942511183 NPI number — STEPHEN DELLA CROCE MS, RD, CDN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DELLA CROCE
Provider First Name:
STEPHEN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, RD, CDN
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:
1942511183
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
440 LAKEVIEW RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLMORE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11710-4209
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-975-7946
Provider Business Mailing Address Fax Number:
866-610-7443

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
405 RXR PLZ
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNIONDALE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11556-3811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-741-6638
Provider Business Practice Location Address Fax Number:
866-610-7443
Provider Enumeration Date:
06/22/2010

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: 133V00000X , with the licence number:  006034 , 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: 100318993601 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9739196293 . This is a "MEDICARE PACID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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