1356553796 NPI number — MRS. MELBA OCAMPO SUAREZ-IAVARONE PT

Table of content: MRS. MELBA OCAMPO SUAREZ-IAVARONE PT (NPI 1356553796)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356553796 NPI number — MRS. MELBA OCAMPO SUAREZ-IAVARONE PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SUAREZ-IAVARONE
Provider First Name:
MELBA
Provider Middle Name:
OCAMPO
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

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:
1356553796
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3935 51ST ST APT 4F
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODSIDE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11377-3168
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-440-7709
Provider Business Mailing Address Fax Number:
718-606-9733

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24 5TH AVE APT 1112
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:
10011-8820
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-685-9334
Provider Business Practice Location Address Fax Number:
212-228-2052
Provider Enumeration Date:
05/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  021408-1 , 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)





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