1033189030 NPI number — DR. STEVEN M EMMETT DO

Table of content: DR. STEVEN M EMMETT DO (NPI 1033189030)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033189030 NPI number — DR. STEVEN M EMMETT DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EMMETT
Provider First Name:
STEVEN
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1033189030
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3104 QUENTIN ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11234-4209
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-339-5544
Provider Business Mailing Address Fax Number:
718-339-4892

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3104 QUENTIN ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11234-4209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-339-5544
Provider Business Practice Location Address Fax Number:
718-339-4892
Provider Enumeration Date:
01/24/2006

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: 208000000X , with the licence number:  103132 , 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: 101031 . This is a "US HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4060662 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 512791 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 970853 . This is a "HERITAGE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0381855 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: P963767 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1201394 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: OP147 . This is a "HIP" identifier . This identifiers is of the category "OTHER".




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