1255425948 NPI number — DR. NELSON SOCORRO MENEZES M.D.

Table of content: DR. NELSON SOCORRO MENEZES M.D. (NPI 1255425948)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255425948 NPI number — DR. NELSON SOCORRO MENEZES M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MENEZES
Provider First Name:
NELSON
Provider Middle Name:
SOCORRO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1255425948
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/18/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
75 88TH STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11209
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-238-2249
Provider Business Mailing Address Fax Number:
718-250-8460

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
186 JORALEMON ST
Provider Second Line Business Practice Location Address:
SUITE 1002
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11201-4356
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-625-4100
Provider Business Practice Location Address Fax Number:
718-625-4900
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2086S0129X , with the licence number:  194948 , 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)

  • Identifier: 20-8604768 . This is a "EMPLOYER IDENTIFICATION N" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01788783 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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