1285121400 NPI number — LIBERTY DENTAL PLAN OF NEW YORK, INC.

Table of content: OLGA LIDIA VIEL DE ARMAS (NPI 1811463417)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285121400 NPI number — LIBERTY DENTAL PLAN OF NEW YORK, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIBERTY DENTAL PLAN OF NEW YORK, INC.
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:
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:
1285121400
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/18/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
340 COMMERCE STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IRVINE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92602-1358
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-703-6999
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
340 COMMERCE STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IRVINE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-703-6999
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/13/2018

Additional Information

Authorized Official

Authorized Official Last Name:
CARVELLI
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
EVP
Authorized Official Telephone Number:
888-703-6999

Provider Taxonomy Codes

  • Taxonomy code: 302R00000X , with the licence number:  XXXX , 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: XXXX , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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