1356891857 NPI number — MR. ELI GENDLER M.D.

Table of content: MR. ELI GENDLER M.D. (NPI 1356891857)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356891857 NPI number — MR. ELI GENDLER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GENDLER
Provider First Name:
ELI
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1356891857
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/30/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1106 1/2 CALIFORNIA AVE
Provider Second Line Business Mailing Address:
UPPER UNIT
Provider Business Mailing Address City Name:
SANTA MONICA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
213-840-8795
Provider Business Mailing Address Fax Number:
213-745-3031

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2501 SOUTH HILL ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-840-8795
Provider Business Practice Location Address Fax Number:
213-536-5845
Provider Enumeration Date:
10/07/2016

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: 208D00000X , with the licence number:  A39904 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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