1265829600 NPI number — MR. TEKPAUL JOSEPH BANSGOPAUL LMSW

Table of content: MR. TEKPAUL JOSEPH BANSGOPAUL LMSW (NPI 1265829600)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265829600 NPI number — MR. TEKPAUL JOSEPH BANSGOPAUL LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BANSGOPAUL
Provider First Name:
TEKPAUL
Provider Middle Name:
JOSEPH
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LMSW
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:
1265829600
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
329EAST 149TH STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRONX
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10451
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-769-2698
Provider Business Mailing Address Fax Number:
718-401-0108

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2625EAST 14TH STREET
Provider Second Line Business Practice Location Address:
200
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-769-2698
Provider Business Practice Location Address Fax Number:
718-401-0108
Provider Enumeration Date:
04/23/2015

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: 104100000X , 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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