1063486934 NPI number — MR. CLIFFORD A MEVS M.D.

Table of content: MR. CLIFFORD A MEVS M.D. (NPI 1063486934)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063486934 NPI number — MR. CLIFFORD A MEVS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEVS
Provider First Name:
CLIFFORD
Provider Middle Name:
A
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1063486934
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/02/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
148 NEW DORP LANE
Provider Second Line Business Mailing Address:
2ND FLOOR
Provider Business Mailing Address City Name:
STATEN ISLAND
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10306
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-980-5437
Provider Business Mailing Address Fax Number:
718-979-2653

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
148 NEW DORP LANE
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
STATEN ISLAND
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-980-5437
Provider Business Practice Location Address Fax Number:
718-979-2653
Provider Enumeration Date:
02/15/2006

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:  160103 , 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: 01214337 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 119803500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com