1033223334 NPI number — DR. STACIE TERRI CALIAN DDS

Table of content: DR. STACIE TERRI CALIAN DDS (NPI 1033223334)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033223334 NPI number — DR. STACIE TERRI CALIAN DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CALIAN
Provider First Name:
STACIE
Provider Middle Name:
TERRI
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SILVERMAN
Provider Other First Name:
STACIE
Provider Other Middle Name:
TERRI
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1033223334
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:
984 NORTH BROADWAY
Provider Second Line Business Mailing Address:
#410
Provider Business Mailing Address City Name:
YONKERS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-476-3838
Provider Business Mailing Address Fax Number:
914-476-3080

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
984 NORTH BROADWAY
Provider Second Line Business Practice Location Address:
#410
Provider Business Practice Location Address City Name:
YONKERS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-476-3838
Provider Business Practice Location Address Fax Number:
914-476-3080
Provider Enumeration Date:
08/17/2006

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: 122300000X , with the licence number:  0416952 , 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: 01142474 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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