1316692866 NPI number — LEON SCRIMMAGER MD

Table of content: MISS BEHROKH NIKKI GOODARZI M.S (NPI 1851570717)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316692866 NPI number — LEON SCRIMMAGER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEON SCRIMMAGER MD
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:
1316692866
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/14/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
470 LENOX AVE APT 1P
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10037-3012
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-249-1627
Provider Business Mailing Address Fax Number:
212-249-1627

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
470 LENOX AVE APT 1P
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10037-3012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-249-1627
Provider Business Practice Location Address Fax Number:
212-249-1627
Provider Enumeration Date:
02/14/2022

Additional Information

Authorized Official

Authorized Official Last Name:
SCRIMMAGER
Authorized Official First Name:
LEON
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
212-249-1627

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , registered in the state of NULL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01435161 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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