1083607790 NPI number — NEAL A. SCKOLNICK

Table of content: NEAL A. SCKOLNICK (NPI 1083607790)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083607790 NPI number — NEAL A. SCKOLNICK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCKOLNICK
Provider First Name:
NEAL
Provider Middle Name:
A.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1083607790
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 HEMPSTEAD AVE
Provider Second Line Business Mailing Address:
SUITE #145
Provider Business Mailing Address City Name:
ROCKVILLE CENTRE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11570-4033
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-678-2222
Provider Business Mailing Address Fax Number:
516-764-1259

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 HEMPSTEAD AVE
Provider Second Line Business Practice Location Address:
SUITE #145
Provider Business Practice Location Address City Name:
ROCKVILLE CENTRE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11570-4033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-678-2222
Provider Business Practice Location Address Fax Number:
516-764-1259
Provider Enumeration Date:
08/27/2005

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: 207R00000X , with the licence number:  131959 , 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: 00425425 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com