1114244415 NPI number — ADVANCED CLINICAL PHYSICIANS, P.L.L.C

Table of content: (NPI 1114244415)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114244415 NPI number — ADVANCED CLINICAL PHYSICIANS, P.L.L.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED CLINICAL PHYSICIANS, P.L.L.C
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:
1114244415
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/26/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11203 QUEENS BLVD STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FOREST HILLS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11375-5550
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-268-8383
Provider Business Mailing Address Fax Number:
718-268-6033

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11203 QUEENS BLVD STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOREST HILLS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11375-5550
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-268-8383
Provider Business Practice Location Address Fax Number:
718-268-6033
Provider Enumeration Date:
04/26/2010

Additional Information

Authorized Official

Authorized Official Last Name:
DOVLATYAN
Authorized Official First Name:
VARUZHAN
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
718-268-8383

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  AAAASF # 3728 , 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: CERT# 3728 . This is a "AAAASF, INC." identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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