1447784806 NPI number — RAMY ELATTAL D.P.M

Table of content: DR. DIANA M TORO PHARMD (NPI 1588267181)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447784806 NPI number — RAMY ELATTAL D.P.M

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ELATTAL
Provider First Name:
RAMY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.P.M
Provider Gender Code:
M

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:
1447784806
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/04/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11245 69TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FOREST HILLS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11375-3917
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
327 BEACH 19TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAR ROCKAWAY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11691-4423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-410-8031
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/12/2017

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0103X , with the licence number: SC007133 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 103790156-0004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 130790156-0002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 103790156-0005 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 103790156-0003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 103790156-0001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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