1104893932 NPI number — MICHAEL S BUCHHOLTZ MD PC

Table of content: (NPI 1104893932)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104893932 NPI number — MICHAEL S BUCHHOLTZ MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHAEL S BUCHHOLTZ MD PC
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:
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:
1104893932
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
270 PULASKI ROAD
Provider Second Line Business Mailing Address:
SUITE D
Provider Business Mailing Address City Name:
GREENLAWN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11740
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
270 PULASKI ROAD
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
GREENLAWN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11740
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-427-6060
Provider Business Practice Location Address Fax Number:
631-549-4858
Provider Enumeration Date:
03/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BUCHHOLTZ
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
S
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
631-427-6060

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 02221227 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com