1205945763 NPI number — MANOOGIAN ORTHOPEDIC CENTER, P.A.

Table of content: (NPI 1205945763)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205945763 NPI number — MANOOGIAN ORTHOPEDIC CENTER, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MANOOGIAN ORTHOPEDIC CENTER, P.A.
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:
1205945763
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/19/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1945 BAY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT DORA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32757-2105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-483-5633
Provider Business Mailing Address Fax Number:
352-483-5070

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1945 BAY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT DORA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32757
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-483-5633
Provider Business Practice Location Address Fax Number:
352-483-5070
Provider Enumeration Date:
08/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MANOOGIAN
Authorized Official First Name:
VREJ
Authorized Official Middle Name:
K
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
352-483-5633

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P00260225 . This is a "RAILROAD MEDICARE GURU" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: DD9204 . This is a "RAILROAD MEDICARE GROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 16714 . This is a "BCBSFL SAMIR GURU, D.O." identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 200041567 . This is a "RAILROAD MEDICARE MANOOGI" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 46883 . This is a "BCBSFL VREJ MANOOGIAN, D." identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 94957 . This is a "BCBSFL GROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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