1457525495 NPI number — FIVE TOWNS OBSTETRICAL & GYNECOLOGICAL ASSOCIATES, P.C.

Table of content: (NPI 1457525495)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457525495 NPI number — FIVE TOWNS OBSTETRICAL & GYNECOLOGICAL ASSOCIATES, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FIVE TOWNS OBSTETRICAL & GYNECOLOGICAL ASSOCIATES, 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:
1457525495
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/05/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1800 ROCKAWAY AVE
Provider Second Line Business Mailing Address:
SUITE 211
Provider Business Mailing Address City Name:
HEWLETT
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11557-1665
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-593-7500
Provider Business Mailing Address Fax Number:
516-593-7535

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1800 ROCKAWAY AVE
Provider Second Line Business Practice Location Address:
SUITE 211
Provider Business Practice Location Address City Name:
HEWLETT
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11557-1665
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-593-7500
Provider Business Practice Location Address Fax Number:
516-593-7535
Provider Enumeration Date:
04/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HIRSCH
Authorized Official First Name:
ALEX
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
516-593-7500

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  156493 , 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: 202274 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 45D821 . This is a "BCBS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0000C05489 . This is a "HEALTHNET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 160025322 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 4225716 . This is a "AETNA PPO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1308147 . This is a "FIRST HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 28677 . This is a "AETNA HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 624 . This is a "VYTRA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P441540 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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