1144218892 NPI number — ROLAND ZSOLT GERENCER MD

Table of content: ROLAND ZSOLT GERENCER MD (NPI 1144218892)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144218892 NPI number — ROLAND ZSOLT GERENCER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GERENCER
Provider First Name:
ROLAND
Provider Middle Name:
ZSOLT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1144218892
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/04/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1020 TIJERAS AVE NE
Provider Second Line Business Mailing Address:
STE 22
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87106-4749
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-858-8503
Provider Business Mailing Address Fax Number:
505-848-8077

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4901 LANG AVE NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87109-4397
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-842-8171
Provider Business Practice Location Address Fax Number:
505-246-0684
Provider Enumeration Date:
10/06/2005

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: 207Y00000X , with the licence number:  99-208 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 040014203 . This is a "GBA PALMETTO - RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 201021487 . This is a "PRESBYTERIAN HEALTH PLAN" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: NM024902 . This is a "BCBS" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: Z6104 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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