1114668969 NPI number — DAYS NURSE PRACTITIONER IN FAMILY HEALTH P.C.

Table of content: DANA CARL RIFFLE DC (NPI 1306863899)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114668969 NPI number — DAYS NURSE PRACTITIONER IN FAMILY HEALTH P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAYS NURSE PRACTITIONER IN FAMILY HEALTH P.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:
1114668969
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15751 19TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHITESTONE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11357-3820
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-881-0690
Provider Business Mailing Address Fax Number:
929-362-2083

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14210 ROOSEVELT AVE STE P10
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLUSHING
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11354-6000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
929-362-2082
Provider Business Practice Location Address Fax Number:
929-362-2083
Provider Enumeration Date:
04/05/2022

Additional Information

Authorized Official

Authorized Official Last Name:
MO
Authorized Official First Name:
SHENGJIE
Authorized Official Middle Name:
Authorized Official Title or Position:
FAMILY PHYSICIAN
Authorized Official Telephone Number:
917-881-0690

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 02265465 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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