1154610160 NPI number — UNLIMITED HOLDINGS GROUP LLC

Table of content: ERIC THOMAS WHITNEY MD (NPI 1164849022)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154610160 NPI number — UNLIMITED HOLDINGS GROUP LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNLIMITED HOLDINGS GROUP LLC
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:
6
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:
1154610160
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6107 UTOPIA PKWY
Provider Second Line Business Mailing Address:
2FL
Provider Business Mailing Address City Name:
FRESH MEADOWS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11365-2155
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-886-6843
Provider Business Mailing Address Fax Number:
718-886-6853

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6107 UTOPIA PKWY
Provider Second Line Business Practice Location Address:
2FL
Provider Business Practice Location Address City Name:
FRESH MEADOWS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11365-2155
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-886-6843
Provider Business Practice Location Address Fax Number:
718-886-6853
Provider Enumeration Date:
03/30/2011

Additional Information

Authorized Official

Authorized Official Last Name:
BARAK
Authorized Official First Name:
AHMAD
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
718-886-6843

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  052876 , 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: 03046559 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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