1376527812 NPI number — PULMONARY & CRITICAL CARE CONSULTANTS, P.C.

Table of content: PAUL ANTHONY NESTERENKO D.C. (NPI 1992811285)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376527812 NPI number — PULMONARY & CRITICAL CARE CONSULTANTS, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PULMONARY & CRITICAL CARE CONSULTANTS, 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:
1376527812
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/12/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
444 MERRICK ROAD
Provider Second Line Business Mailing Address:
SUITE LL1
Provider Business Mailing Address City Name:
LYNBROOK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11563
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-593-9500
Provider Business Mailing Address Fax Number:
516-593-9048

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
444 MERRICK ROAD
Provider Second Line Business Practice Location Address:
SUITE LL1
Provider Business Practice Location Address City Name:
LYNBROOK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11563
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-593-9500
Provider Business Practice Location Address Fax Number:
516-593-9048
Provider Enumeration Date:
11/29/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HENNER
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
I
Authorized Official Title or Position:
PRACTICE ADMIN
Authorized Official Telephone Number:
516-593-9500

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01091689 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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