1245489509 NPI number — METRO PHYSICIAN ASSOCIATES LLP

Table of content: (NPI 1245489509)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245489509 NPI number — METRO PHYSICIAN ASSOCIATES LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
METRO PHYSICIAN ASSOCIATES 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:
1245489509
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1816
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10159-1816
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-475-8066
Provider Business Mailing Address Fax Number:
212-475-4175

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6062 PALMETTO ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIDGEWOOD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11385-3241
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-475-8066
Provider Business Practice Location Address Fax Number:
212-475-4175
Provider Enumeration Date:
09/11/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HERWIG
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
JOHN
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
212-475-8066

Provider Taxonomy Codes

  • Taxonomy code: 207UN0901X , with the licence number:  114071 , 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)





Copyright © 2007-2025 www.npivalidator.com