1154639730 NPI number — MS. KAYANNA EMELY PATTERSON P.A.-C

Table of content: MS. KAYANNA EMELY PATTERSON P.A.-C (NPI 1154639730)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154639730 NPI number — MS. KAYANNA EMELY PATTERSON P.A.-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PATTERSON
Provider First Name:
KAYANNA
Provider Middle Name:
EMELY
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
P.A.-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MORRISON
Provider Other First Name:
KAYANNA
Provider Other Middle Name:
EMELY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1154639730
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/15/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7901 BROADWAY DEPT OF
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELMHURST
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11373-1329
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-334-3392
Provider Business Mailing Address Fax Number:
718-334-5886

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1650 GRAND CONCOURSE
Provider Second Line Business Practice Location Address:
BRONX LEBANON HOSPITAL CENTER-ENT DEPARTMENT
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10457-7606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-901-6901
Provider Business Practice Location Address Fax Number:
718-518-5280
Provider Enumeration Date:
09/17/2010

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: 363A00000X , with the licence number:  013997 , 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)





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