1427216472 NPI number — DR LEVIN GOLDMANN EZRA

Table of content: (NPI 1427216472)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427216472 NPI number — DR LEVIN GOLDMANN EZRA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR LEVIN GOLDMANN EZRA
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:
1427216472
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1301 CORNAGA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAR ROCKAWAY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11691
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-327-6592
Provider Business Mailing Address Fax Number:
718-327-2206

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1229 BROADWAY
Provider Second Line Business Practice Location Address:
SUITE 207
Provider Business Practice Location Address City Name:
HEWLETT
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11557
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-374-2215
Provider Business Practice Location Address Fax Number:
516-374-0340
Provider Enumeration Date:
05/27/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ANDREWS
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
M
Authorized Official Title or Position:
RECEPTIONIST
Authorized Official Telephone Number:
718-327-6592

Provider Taxonomy Codes

  • Taxonomy code: 204E00000X , with the licence number:  040873 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 204E00000X , with the licence number: 26221 , 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: 00281970 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01406275 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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