1033284906 NPI number — DR. NICOLETTE ERICA FILITIS MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033284906 NPI number — DR. NICOLETTE ERICA FILITIS MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

FILITIS

Provider First Name:

NICOLETTE

Provider Middle Name:

ERICA

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

F

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:

1033284906

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

07/08/2007

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

18 SLAYTON AVE

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

STATEN ISLAND

Provider Business Mailing Address State Name:

NY

Provider Business Mailing Address Postal Code:

10314-4976

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

718-233-1173

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

741 JEWETT AVE

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

STATEN ISLAND

Provider Business Practice Location Address State Name:

NY

Provider Business Practice Location Address Postal Code:

10314-2809

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

718-816-0101

Provider Business Practice Location Address Fax Number:

718-816-9595

Provider Enumeration Date:

11/22/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207R00000X , with the licence number:  222241-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 2685367 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 02225294 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
• Identifier: 4989395003 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: P2632316 . This is a "OXFORD FREEDOM LIBERTY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 222241P . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 091AF1 . This is a "EMPIRE BCBS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 2594555 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 82738 . This is a "GHI HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 1P0154 . This is a "TOUCHTONE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 173152 . This is a "ELDER PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 2151913 AARP . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: FN2241 . This is a "ATLANTIS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".