1407290778 NPI number — ANA MARIA LEON GOMEZ MATUTE MSC

Table of content: ANA MARIA LEON GOMEZ MATUTE MSC (NPI 1407290778)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407290778 NPI number — ANA MARIA LEON GOMEZ MATUTE MSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEON GOMEZ MATUTE
Provider First Name:
ANA
Provider Middle Name:
MARIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSC
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:
1407290778
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/17/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5 GREAT JONES ST APT 9
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10012-1157
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
646-626-9271
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3636 33RD ST
Provider Second Line Business Practice Location Address:
SUITE 500
Provider Business Practice Location Address City Name:
ASTORIA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11106-2329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-426-8110
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/17/2013

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: 101YM0800X , with the licence number:  P85280 , 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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