1275886541 NPI number — SALBY SIMON MAKIL

Table of content: SALBY SIMON MAKIL (NPI 1275886541)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275886541 NPI number — SALBY SIMON MAKIL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAKIL
Provider First Name:
SALBY
Provider Middle Name:
SIMON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SIMON
Provider Other First Name:
SALBY
Provider Other Middle Name:
MAKIL
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:
1275886541
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/14/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
96 DOGWOOD LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW HYDE PARK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11040-2310
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-375-2237
Provider Business Mailing Address Fax Number:
212-656-1091

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
346 BEEBE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MINEOLA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11501-1112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-470-1266
Provider Business Practice Location Address Fax Number:
516-279-4174
Provider Enumeration Date:
10/23/2012

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: 225100000X , with the licence number:  022383 , 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)