1992738769 NPI number — ARAMIS ANTONIO BERMUDEZ D.O.

Table of content: ARAMIS ANTONIO BERMUDEZ D.O. (NPI 1992738769)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992738769 NPI number — ARAMIS ANTONIO BERMUDEZ D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BERMUDEZ
Provider First Name:
ARAMIS
Provider Middle Name:
ANTONIO
Provider Name Prefix Text:
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:
1992738769
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5-02 SUMMIT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIR LAWN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07410-2162
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-797-7037
Provider Business Mailing Address Fax Number:
212-567-3777

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2016 BRONXDALE AVE
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10462-3388
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-918-1372
Provider Business Practice Location Address Fax Number:
718-918-1301
Provider Enumeration Date:
07/07/2006

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:  207135 , 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: 01973977 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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