1154679728 NPI number — MRS. SANDRA SUSAN BLOCK-EFFRON

Table of content: MRS. SANDRA SUSAN BLOCK-EFFRON (NPI 1154679728)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154679728 NPI number — MRS. SANDRA SUSAN BLOCK-EFFRON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLOCK-EFFRON
Provider First Name:
SANDRA
Provider Middle Name:
SUSAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

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:
1154679728
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5959 INDEPENDENCE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRONX
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10471-1222
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-796-4200
Provider Business Mailing Address Fax Number:
718-549-3465

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5959 INDEPENDENCE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10471-1222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-796-4200
Provider Business Practice Location Address Fax Number:
718-549-3465
Provider Enumeration Date:
08/29/2012

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: 374T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 376G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





Copyright © 2007-2025 www.npivalidator.com