1427047406 NPI number — DR. PHOEBE TIN TIN MA DMD

Table of content: DR. PHOEBE TIN TIN MA DMD (NPI 1427047406)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427047406 NPI number — DR. PHOEBE TIN TIN MA DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MA
Provider First Name:
PHOEBE
Provider Middle Name:
TIN TIN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MA
Provider Other First Name:
TIN
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DMD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1427047406
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
98 E. BROADWAY
Provider Second Line Business Mailing Address:
SUITE 501
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10002-7181
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-227-4349
Provider Business Mailing Address Fax Number:
212-227-3216

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
98 E. BROADWAY
Provider Second Line Business Practice Location Address:
SUITE 501
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10002-7181
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-227-4349
Provider Business Practice Location Address Fax Number:
212-227-3216
Provider Enumeration Date:
10/20/2005

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: 122300000X , with the licence number:  047792 , 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: 01892277 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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