1275992034 NPI number — ENDOCRINE TECHNOLOGY, LLC

Table of content: (NPI 1275992034)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275992034 NPI number — ENDOCRINE TECHNOLOGY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ENDOCRINE TECHNOLOGY, LLC
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:
6
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:
1275992034
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/22/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
230 HILTON AVE
Provider Second Line Business Mailing Address:
SUITE 17
Provider Business Mailing Address City Name:
HEMPSTEAD
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11550-8180
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
347-302-3107
Provider Business Mailing Address Fax Number:
718-222-1350

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
230 HILTON AVE
Provider Second Line Business Practice Location Address:
SUITE 17
Provider Business Practice Location Address City Name:
HEMPSTEAD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11550-8115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-302-3107
Provider Business Practice Location Address Fax Number:
718-222-1350
Provider Enumeration Date:
02/22/2016

Additional Information

Authorized Official

Authorized Official Last Name:
SHAH
Authorized Official First Name:
KUMARPAL
Authorized Official Middle Name:
AMBALAL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
347-302-3107

Provider Taxonomy Codes

  • Taxonomy code: 207RE0101X , with the licence number:  139486 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QH0100X , with the licence number: 139486 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 100901000078 . This is a "FIDELIS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 112009 . This is a "EMPIRE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 340290101 . This is a "HEALTH FIRST" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 011549885 . This is a "MAGNACARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1093995524 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00770576 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 112009 . This is a "EMBLEM" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 67A031 . This is a "BLUESHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P00106364 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P2090111 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 139486 . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: N214201 . This is a "WELLCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 193525 . This is a "ELDERPLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 996181 . This is a "NEIGHOURHOOD PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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