1093980658 NPI number — LEVITTOWN CLINICAL CENTER PSC

Table of content: (NPI 1093980658)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093980658 NPI number — LEVITTOWN CLINICAL CENTER PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEVITTOWN CLINICAL CENTER PSC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LEVITTOWN MEDICAL GROUP
Provider Other Organization Name Type Code:
5
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:
1093980658
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1784
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SABANA SECA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00952-1784
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-998-7462
Provider Business Mailing Address Fax Number:
787-998-7542

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AVE LOS DOMINICOS RH 8
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEVITTOWN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00949
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-998-7462
Provider Business Practice Location Address Fax Number:
787-998-7542
Provider Enumeration Date:
04/24/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MARTINEZ-SUAREZ
Authorized Official First Name:
ROBERTO
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
787-998-7462

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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