1144346149 NPI number — JAMES MICHAEL FATOLITIS NP

Table of content: JAMES MICHAEL FATOLITIS NP (NPI 1144346149)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144346149 NPI number — JAMES MICHAEL FATOLITIS NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FATOLITIS
Provider First Name:
JAMES
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
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:
1144346149
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
730 FORT WASHINGTON AVE APT 5M
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10040-3748
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-927-2029
Provider Business Mailing Address Fax Number:
212-342-8541

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
161 FT. WASHINGTON AVE
Provider Second Line Business Practice Location Address:
7TH FLOOR PEDS ONC
Provider Business Practice Location Address City Name:
NEW YORK CITY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-305-9770
Provider Business Practice Location Address Fax Number:
212-305-5848
Provider Enumeration Date:
03/21/2007

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: 363LP0200X , with the licence number:  F381221 , 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: F 381221 . This is a "NP LICENSE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com