1336445352 NPI number — FRED WARREN D.P.M.,P.C.

Table of content: (NPI 1336445352)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336445352 NPI number — FRED WARREN D.P.M.,P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FRED WARREN D.P.M.,P.C.
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:
1336445352
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/09/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15274 JEWEL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLUSHING
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11367-1436
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-261-7373
Provider Business Mailing Address Fax Number:
718-261-7373

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15274 JEWEL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLUSHING
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11367-1436
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-261-7373
Provider Business Practice Location Address Fax Number:
718-261-7373
Provider Enumeration Date:
02/09/2011

Additional Information

Authorized Official

Authorized Official Last Name:
WARREN
Authorized Official First Name:
FRED
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
718-261-7373

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  N003300 , 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: P35241 . This is a "EMPIRE BC/BS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P53092 . This is a "MEDICARE(EMPIRE)" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 4715140001 . This is a "MEDICARE(DMEPOS)" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P53091ANDP3092 . This is a "EMPIRE PPO/EPO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0079443 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P2790041 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: HIP00304 . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00687554 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com