1144269911 NPI number — BAKER BREAST PROSTHESIS & SURGICAL STOCKINGS CORP.

Table of content: (NPI 1144269911)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144269911 NPI number — BAKER BREAST PROSTHESIS & SURGICAL STOCKINGS CORP.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAKER BREAST PROSTHESIS & SURGICAL STOCKINGS CORP.
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:
MY SECRET
Provider Other Organization Name Type Code:
3
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:
1144269911
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
145 W 71ST ST
Provider Second Line Business Mailing Address:
SUITE 1F
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10023-3802
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-877-8860
Provider Business Mailing Address Fax Number:
212-799-8356

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
145 W 71ST ST
Provider Second Line Business Practice Location Address:
SUITE 1F
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10023-3802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-877-8860
Provider Business Practice Location Address Fax Number:
212-799-8356
Provider Enumeration Date:
06/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ELBAUM
Authorized Official First Name:
ETTY
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
212-877-8860

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 120423 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: G71532 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 57C0601 . This is a "COMMUNITY PREMIER PLUS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 040401001486 . This is a "FIDELIS CARE OF NY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1000002744 . This is a "AFFINITY HEALTH PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2C3110 . This is a "HEALTHNET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 57P0471 . This is a "COMMUNITY HEALTH PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: A395883 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01261343 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 174138 . This is a "ELDERPLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1068780 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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