1467483958 NPI number — JULIET OVSHAYEV D.O.

Table of content: JULIET OVSHAYEV D.O. (NPI 1467483958)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467483958 NPI number — JULIET OVSHAYEV D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OVSHAYEV
Provider First Name:
JULIET
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
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:
1467483958
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/15/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6 MELNICK DR.
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
MONSEY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10952
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-352-9292
Provider Business Mailing Address Fax Number:
845-352-1252

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6 MELNICK DR.
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
MONSEY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10952
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-352-9292
Provider Business Practice Location Address Fax Number:
845-352-1252
Provider Enumeration Date:
07/05/2006

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: 207Q00000X , with the licence number:  220616 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X , with the licence number: 25MB07494800 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 02199631 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com