1114002441 NPI number — DR. SALVATORE INSERRA MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114002441 NPI number — DR. SALVATORE INSERRA MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

INSERRA

Provider First Name:

SALVATORE

Provider Middle Name:

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

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:

1114002441

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

06/30/2016

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

45 RESEARCH WAY

Provider Second Line Business Mailing Address:

STE 105

Provider Business Mailing Address City Name:

EAST SETAUKET

Provider Business Mailing Address State Name:

NY

Provider Business Mailing Address Postal Code:

11733-6401

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

631-675-2125

Provider Business Mailing Address Fax Number:

631-675-2624

Provider First Line Business Practice Location Address:

309 MIDDLE COUNTRY RD

Provider Second Line Business Practice Location Address:

STE 101

Provider Business Practice Location Address City Name:

SMITHTOWN

Provider Business Practice Location Address State Name:

NY

Provider Business Practice Location Address Postal Code:

11787

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

631-360-2200

Provider Business Practice Location Address Fax Number:

631-360-1328

Provider Enumeration Date:

10/26/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207X00000X , with the licence number:  145138-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 0919077 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 4288391 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 0069854 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 14D891 . This is a "BLUE CROSS BLUE SHEILD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 488345 . This is a "UNITEDHEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 00821572 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
• Identifier: 200008348 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 2C1476 . This is a "HEALTHNET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: W21941 . This is a "MEDICARE GROUP PTAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: CS142 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 14D891 . This is a "BC/BS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".