1992706402 NPI number — DR. ALLAN SCOTT DETWEILER D.O.

Table of content: DR. ALLAN SCOTT DETWEILER D.O. (NPI 1992706402)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992706402 NPI number — DR. ALLAN SCOTT DETWEILER D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DETWEILER
Provider First Name:
ALLAN
Provider Middle Name:
SCOTT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
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:
1992706402
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/17/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
271 DOUGHTY BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INWOOD
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11096-2135
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-371-6884
Provider Business Mailing Address Fax Number:
516-371-6083

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
271 DOUGHTY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INWOOD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11096-2135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-371-6884
Provider Business Practice Location Address Fax Number:
516-371-6083
Provider Enumeration Date:
08/09/2005

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:  205232 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X , with the licence number: OS0007505 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 05V551 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 160447 . This is a "ELDERPLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 05V552 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 38780A . This is a "CIGNA PPO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 131701 . This is a "CHN CONSUMER HEALTH NET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2064925 . This is a "AETNA HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 58-2388280 . This is a "CHOICE CARE HUMANA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: TAX ID 58-2388280 . This is a "AMER.MEDICAL & LIFE INS." identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 040426008913 . This is a "FIDELIS CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 58-2388280 . This is a "DEVON" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 98413 . This is a "AETNA US HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 38780A . This is a "CIGNA HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 58-2388280 . This is a "BEECH STREET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 58-2388280 . This is a "EMPIRE PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 58-2388280 E69914 . This is a "AMERIHEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 040927000056 . This is a "FIDELIS CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 33565040205232NY01 . This is a "ANTHEM HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5235644 . This is a "AETNA PPO/POS PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: DA5232 . This is a "ATLANTIS HEALTH PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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