1194864314 NPI number — NEIL L. BELLET M.D. AND LAWRENCE M. WELLS M.D.,LLP

Table of content: (NPI 1194864314)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194864314 NPI number — NEIL L. BELLET M.D. AND LAWRENCE M. WELLS M.D.,LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEIL L. BELLET M.D. AND LAWRENCE M. WELLS M.D.,LLP
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:
1194864314
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1735 N OCEAN AVE
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
MEDFORD
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11763-2649
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-475-5550
Provider Business Mailing Address Fax Number:
631-475-5584

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1735 N OCEAN AVE
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
MEDFORD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11763-2649
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-475-5550
Provider Business Practice Location Address Fax Number:
631-475-5584
Provider Enumeration Date:
02/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BELLET
Authorized Official First Name:
NEIL
Authorized Official Middle Name:
L
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
631-475-5550

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 106532 . This is a "HIP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0807740 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2299975 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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