1114189735 NPI number — NUTAN ANAND PHYSICIAN PC

Table of content: (NPI 1114189735)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114189735 NPI number — NUTAN ANAND PHYSICIAN PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NUTAN ANAND PHYSICIAN 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:
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:
1114189735
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 63
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SYOSSET
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11791-0063
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-689-7300
Provider Business Mailing Address Fax Number:
631-689-7321

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
205 OSBORNE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIVERHEAD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11901-3021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-727-6025
Provider Business Practice Location Address Fax Number:
631-727-6044
Provider Enumeration Date:
06/25/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ANAND
Authorized Official First Name:
AZAD
Authorized Official Middle Name:
K
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
631-689-7300

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  138079 , 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: 00571857 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1821124512 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 211029 . This is a "SECOND SITE FDA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1548201353 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1689700403 . This is a "NPI #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1902838816 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 51014000 . This is a "NYS DEPARTMENT OF HEALTH RADIATION CERTIFICATION" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 120964 . This is a "FDA #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1679609457 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 167312 . This is a "FDA NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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