1184176570 NPI number — ALLIANCE SERVICES FOR TBI, INC

Table of content: DONNA MAE DALTON CNP (NPI 1710317813)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184176570 NPI number — ALLIANCE SERVICES FOR TBI, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLIANCE SERVICES FOR TBI, INC
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:
1184176570
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/01/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24707 JERICHO TPKE
Provider Second Line Business Mailing Address:
SUITE A3
Provider Business Mailing Address City Name:
BELLEROSE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11426-1531
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-915-7837
Provider Business Mailing Address Fax Number:
888-894-0540

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24707 JERICHO TPKE
Provider Second Line Business Practice Location Address:
SUITE A3
Provider Business Practice Location Address City Name:
BELLEROSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11426-1531
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-915-7837
Provider Business Practice Location Address Fax Number:
888-894-0540
Provider Enumeration Date:
11/01/2016

Additional Information

Authorized Official

Authorized Official Last Name:
PAUL
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
718-501-2637

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 03053252 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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