1275635369 NPI number — MS. MARY E SHOWSTARK PA C

Table of content: MS. MARY E SHOWSTARK PA C (NPI 1275635369)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275635369 NPI number — MS. MARY E SHOWSTARK PA C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHOWSTARK
Provider First Name:
MARY
Provider Middle Name:
E
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PA C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHOWSTARK
Provider Other First Name:
MARY
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1275635369
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27 W 23RD ST
Provider Second Line Business Mailing Address:
PHYSICIAN ASSISTANT PROGRAM
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10010-4202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-463-0400
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27 W 23RD ST # 33
Provider Second Line Business Practice Location Address:
PHYSICIAN ASSISTANT PROGRAM
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10010-4202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-463-0400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/01/2006

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: 363AS0400X , with the licence number:  AMD-284 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: PA18197 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: AMD-284 . This is a "HI-LIC" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: PA18197 . This is a "CA PA-C" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 014709-1 . This is a "NYS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: PA9102873 . This is a "FL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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