1003034398 NPI number — MS. MISTY L CHIU FNP

Table of content: MS. MISTY L CHIU FNP (NPI 1003034398)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003034398 NPI number — MS. MISTY L CHIU FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHIU
Provider First Name:
MISTY
Provider Middle Name:
L
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LANDERS
Provider Other First Name:
MISTY
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1003034398
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/17/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 PARK AVE, 4 W
Provider Second Line Business Mailing Address:
HOPE CENTER
Provider Business Mailing Address City Name:
YONKERS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-964-7723
Provider Business Mailing Address Fax Number:
914-964-7321

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 PARK AVE, 4 W
Provider Second Line Business Practice Location Address:
HOPE CENTER
Provider Business Practice Location Address City Name:
YONKERS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-964-7723
Provider Business Practice Location Address Fax Number:
914-964-7321
Provider Enumeration Date:
04/23/2007

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: 163WM0705X , with the licence number:  561968 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: F335140 , 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)