1982820213 NPI number — MOHAWK OPPORTUNITIES, INC.

Table of content: (NPI 1982820213)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982820213 NPI number — MOHAWK OPPORTUNITIES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOHAWK OPPORTUNITIES, INC.
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:
1982820213
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/24/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 NOTT TERRACE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCHENECTADY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12307
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-374-8424
Provider Business Mailing Address Fax Number:
518-374-8440

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 NOTT TERRACE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCHENECTADY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-374-8424
Provider Business Practice Location Address Fax Number:
518-374-8440
Provider Enumeration Date:
04/17/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GALLAGHER
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
518-374-8424

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  7638470A , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 320800000X , with the licence number: 7638430 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320800000X , with the licence number: 7638434 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320800000X , with the licence number: 7638432 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320800000X , with the licence number: 7638435 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320800000X , with the licence number: 7638431 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 02752752 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01304407 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".