1437428885 NPI number — ELLANA SANDERS MT- BC LCAT, CCBT

Table of content: ELLANA SANDERS MT- BC LCAT, CCBT (NPI 1437428885)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437428885 NPI number — ELLANA SANDERS MT- BC LCAT, CCBT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANDERS
Provider First Name:
ELLANA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MT- BC LCAT, CCBT
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:
1437428885
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3850 BELL BLVD
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
BAYSIDE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11361-2168
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-520-7476
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3850 BELL BLVD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
BAYSIDE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11361-2168
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-520-7476
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/14/2011

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:  000817-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225A00000X , with the licence number: BC , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 000817-1 . This is a "NYS OFFICE OF THE PROFFESSIONS" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com