1174822845 NPI number — CLARA YENTIN TOW

Table of content: CLARA YENTIN TOW (NPI 1174822845)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174822845 NPI number — CLARA YENTIN TOW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TOW
Provider First Name:
CLARA
Provider Middle Name:
YENTIN
Provider Name Prefix Text:
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:
1174822845
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15 SANDPIPER CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SMITHTOWN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11787-3325
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-807-0785
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
505 E 70TH ST
Provider Second Line Business Practice Location Address:
WEILL CORNELL INTERNAL MEDICINE ASSOCIATES
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10021-4872
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-746-3587
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/21/2011

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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