1134175839 NPI number — ANNETTE VISCONTI MD

Table of content: ANNETTE VISCONTI MD (NPI 1134175839)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134175839 NPI number — ANNETTE VISCONTI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VISCONTI
Provider First Name:
ANNETTE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1134175839
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 681
Provider Second Line Business Mailing Address:
VAN BURNT STATION
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11215
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-666-2455
Provider Business Mailing Address Fax Number:
610-617-6280

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
506 6TH ST
Provider Second Line Business Practice Location Address:
THE METHODIST HOSPITAL
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-780-3159
Provider Business Practice Location Address Fax Number:
610-617-6280
Provider Enumeration Date:
05/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  207272 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: 207474 , 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: 01793315 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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