1073666038 NPI number — BRUCE M WEBBER L.C.S.W.

Table of content: BRUCE M WEBBER L.C.S.W. (NPI 1073666038)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073666038 NPI number — BRUCE M WEBBER L.C.S.W.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEBBER
Provider First Name:
BRUCE
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
L.C.S.W.
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:
1073666038
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:
19105 35TH AVE
Provider Second Line Business Mailing Address:
APT. I
Provider Business Mailing Address City Name:
FLUSHING
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11358-1900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
646-522-4121
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
35 E 35TH ST
Provider Second Line Business Practice Location Address:
SUITE 1-M
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10016-3823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
646-522-4121
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/20/2007

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: 1041C0700X , with the licence number:  R055524-1 , 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: P2576834 . This is a "OXFORD HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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