1124295944 NPI number — RESIDENT CARE MEDICINE OF NEW YORK, PLLC

Table of content: (NPI 1124295944)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124295944 NPI number — RESIDENT CARE MEDICINE OF NEW YORK, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RESIDENT CARE MEDICINE OF NEW YORK, PLLC
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:
1124295944
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/24/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 PROGRESS DR
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
SHELTON
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06484-6216
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-538-8028
Provider Business Mailing Address Fax Number:
866-303-0041

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
34-12 36TH ST SUITE 220
Provider Second Line Business Practice Location Address:
RESIDENT CARE MEDICINE OF NEW YORK LLC
Provider Business Practice Location Address City Name:
ASTORIA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-530-5863
Provider Business Practice Location Address Fax Number:
866-303-0041
Provider Enumeration Date:
05/12/2008

Additional Information

Authorized Official

Authorized Official Last Name:
CHESS
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
203-925-9600

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com