1366601189 NPI number — BERNABE GENERAL DENTISTRY PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366601189 NPI number — BERNABE GENERAL DENTISTRY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BERNABE GENERAL DENTISTRY PC
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:
1366601189
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1916 GRAND CONCOURSE
Provider Second Line Business Mailing Address:
SUITE 1A
Provider Business Mailing Address City Name:
BRONX
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10457-5201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-716-1400
Provider Business Mailing Address Fax Number:
718-716-7025

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1916 GRAND CONCOURSE
Provider Second Line Business Practice Location Address:
SUITE 1A
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10457-5201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-716-1400
Provider Business Practice Location Address Fax Number:
718-716-7025
Provider Enumeration Date:
06/06/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BERNABE
Authorized Official First Name:
HECTOR
Authorized Official Middle Name:
BOLIVAR
Authorized Official Title or Position:
DENTIST/PRESIDENT
Authorized Official Telephone Number:
718-716-1400

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  043696 , 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: 01277687 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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