1154813137 NPI number — ACTIVE MEDICAL CARE PC

Table of content: (NPI 1154813137)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154813137 NPI number — ACTIVE MEDICAL CARE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACTIVE MEDICAL CARE PC
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:
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:
1154813137
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/12/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
275 N MIDDLETOWN RD STE 1F
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEARL RIVER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10965-1189
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-376-6100
Provider Business Mailing Address Fax Number:
914-231-6872

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
275 N MIDDLETOWN RD STE 1F
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEARL RIVER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10965
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-376-6100
Provider Business Practice Location Address Fax Number:
914-231-6872
Provider Enumeration Date:
06/05/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SHEIK
Authorized Official First Name:
EDNAN
Authorized Official Middle Name:
S
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
215-593-5484

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2081P2900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2083T0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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