1104870203 NPI number — THE MARION AND AARON GURAL JCC INC

Table of content: ALI DANIELLE LOFLIN CRNP (NPI 1801494661)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104870203 NPI number — THE MARION AND AARON GURAL JCC INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE MARION AND AARON GURAL JCC INC
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:
Provider Other Organization Name Type Code:
6
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:
1104870203
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/18/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
207 GROVE AVE.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CEDARHURST
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11516
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-569-6733
Provider Business Mailing Address Fax Number:
516-569-6917

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
207 GROVE AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CEDARHURST
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-569-6733
Provider Business Practice Location Address Fax Number:
516-569-6917
Provider Enumeration Date:
05/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DANIELS
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
516-569-6733

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  0558111 , 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)





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