1003889700 NPI number — MARFATIA MEDICAL PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003889700 NPI number — MARFATIA MEDICAL PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARFATIA MEDICAL PLLC
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:
1003889700
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
214 WYOMING ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WARSAW
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14569-9523
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-786-2769
Provider Business Mailing Address Fax Number:
585-786-0508

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5596 ROUTE 19A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CASTILE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14427-9757
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-493-9230
Provider Business Practice Location Address Fax Number:
585-786-0508
Provider Enumeration Date:
02/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COOPER
Authorized Official First Name:
RASHNA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
585-786-2769

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  224172 , 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: 000525403002 . This is a "BCBS WNY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0410493 . This is a "INDEPENDENT HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2710199 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 224172-7B . This is a "WORKERS COMPENSATION" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 106101BJ . This is a "PREFERRED CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7774326 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00010372202 . This is a "UNIVERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000525403003 . This is a "BCBS WNY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2514266 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01916687 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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