1285724914 NPI number — SEMMA MEDICAL PLLC

Table of content: (NPI 1285724914)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285724914 NPI number — SEMMA MEDICAL PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SEMMA MEDICAL PLLC
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:
1285724914
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2414 33RD ST
Provider Second Line Business Mailing Address:
STE A
Provider Business Mailing Address City Name:
ASTORIA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11102-1137
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-932-7315
Provider Business Mailing Address Fax Number:
718-956-0254

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2414 33RD ST
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
ASTORIA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11102-1137
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-932-7315
Provider Business Practice Location Address Fax Number:
718-956-0254
Provider Enumeration Date:
10/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ALEXIS
Authorized Official First Name:
ELISABETH
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
718-932-7315

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  144701-1 , 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: 000348070301 . This is a "HEALTH PLUS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 010255102 . This is a "AMERICHOICE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01148241 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000152630501 . This is a "HEALTH PLUS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 06068 . This is a "GHI MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 137667143 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 181085P . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 425AN1 . This is a "EMPIRE BLUE CROSS BLUE SH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 137667143A01 . This is a "CAREPLUS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 425AN2 . This is a "EMPIRE BLUE CROSS BLUE SH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 425AN3 . This is a "EMPIRE BLUE CROSS BLUE SH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P3118171 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 81F951 . This is a "EMPIRE BLUECROSS BLUE SHE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000087179 . This is a "GHI HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 232908 . This is a "WELLCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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