1205369774 NPI number — ADELANTE OF SUFFOLK COUNTY, INC.

Table of content: FERNANDO CONTRERAS SOARES M.D. (NPI 1528372117)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205369774 NPI number — ADELANTE OF SUFFOLK COUNTY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADELANTE OF SUFFOLK COUNTY, 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:
1205369774
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/11/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
191 SWEET HOLLOW RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OLD BETHPAGE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11804-1314
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-870-1600
Provider Business Mailing Address Fax Number:
516-870-1658

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
83 CARLTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CENTRAL ISLIP
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11722-3019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-870-1600
Provider Business Practice Location Address Fax Number:
516-870-1658
Provider Enumeration Date:
04/11/2017

Additional Information

Authorized Official

Authorized Official Last Name:
BUDD
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
516-870-1600

Provider Taxonomy Codes

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

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





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