1427455864 NPI number — DANIELLE M. PHILLIPS MD P.C.

Table of content: AMANDA LEIGH RITTER BCBA (NPI 1407512841)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427455864 NPI number — DANIELLE M. PHILLIPS MD P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DANIELLE M. PHILLIPS MD 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:
1427455864
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/01/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1917 BEDFORD AVE
Provider Second Line Business Mailing Address:
GROUND FLOOR
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11225-5306
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-469-1900
Provider Business Mailing Address Fax Number:
718-469-1902

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1917 BEDFORD AVE
Provider Second Line Business Practice Location Address:
GROUND FLOOR
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11225-5306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-469-1900
Provider Business Practice Location Address Fax Number:
718-469-1902
Provider Enumeration Date:
12/01/2014

Additional Information

Authorized Official

Authorized Official Last Name:
PHILLIPS
Authorized Official First Name:
DANIELLE
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
718-469-1900

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  229021 , 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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