1952689853 NPI number — DR ELSIE WITT-BOCKLER, PHYSICIAN PC

Table of content: MRS. BARBARA JOYCE AUSTIN APNP (NPI 1336651447)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952689853 NPI number — DR ELSIE WITT-BOCKLER, PHYSICIAN PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR ELSIE WITT-BOCKLER, PHYSICIAN PC
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:
1952689853
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/26/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
87 GLEN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEA CLIFF
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11579-1430
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-671-0445
Provider Business Mailing Address Fax Number:
516-759-7975

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
87 GLEN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEA CLIFF
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11579-1430
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-671-0445
Provider Business Practice Location Address Fax Number:
516-759-7975
Provider Enumeration Date:
07/26/2011

Additional Information

Authorized Official

Authorized Official Last Name:
WITT-BOCKLER
Authorized Official First Name:
ELSIE
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
516-671-0445

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  180772 , 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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