1285744540 NPI number — EFCC ACQUISITION CORP

Table of content: (NPI 1285744540)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285744540 NPI number — EFCC ACQUISITION CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EFCC ACQUISITION CORP
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:
1285744540
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/16/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
115 BROADHOLLOW RD
Provider Second Line Business Mailing Address:
275
Provider Business Mailing Address City Name:
MELVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11747-4992
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-223-0908
Provider Business Mailing Address Fax Number:
631-427-5466

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3424 WILLIAM PENN HWY
Provider Second Line Business Practice Location Address:
SUITE 220
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15235-5444
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-241-7292
Provider Business Practice Location Address Fax Number:
412-241-7288
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STERNBACH
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
631-423-6689

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  77430500 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1007772400005 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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