1356839021 NPI number — BROOKLYN FAMILY SERVICE INSTITUTE

Table of content: DR. IZEWSKA L LESPIER MD (NPI 1427121771)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356839021 NPI number — BROOKLYN FAMILY SERVICE INSTITUTE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BROOKLYN FAMILY SERVICE INSTITUTE
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:
1356839021
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/27/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1300 MERCANTILE LN STE 136C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LARGO
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20774-5332
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-512-4689
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1004 E PATAPSCO AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21225-2229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-512-4689
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/27/2018

Additional Information

Authorized Official

Authorized Official Last Name:
GLYNN
Authorized Official First Name:
DENISE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
301-512-4689

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  09850 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 688703100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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