1023164571 NPI number — NEPHROLOGY SERVICES MEDICAL GROUP OF OLEAN & BRADFORD, PC

Table of content: REMEDIOS ADAN BABANTO FNP (NPI 1669520011)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023164571 NPI number — NEPHROLOGY SERVICES MEDICAL GROUP OF OLEAN & BRADFORD, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEPHROLOGY SERVICES MEDICAL GROUP OF OLEAN & BRADFORD, PC
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:
1023164571
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 583
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OLEAN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14760-0583
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-372-4212
Provider Business Mailing Address Fax Number:
716-373-9167

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
623 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OLEAN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14760-1515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-372-4212
Provider Business Practice Location Address Fax Number:
716-373-9167
Provider Enumeration Date:
01/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JAVED
Authorized Official First Name:
MUHAMMED
Authorized Official Middle Name:
T
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
716-372-4212

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  193890-1 , 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: 02353684 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01452253 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01546870 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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