1477545473 NPI number — DR. LOUISA POLO RAMONE M.D. , FAAP

Table of content: DR. LOUISA POLO RAMONE M.D. , FAAP (NPI 1477545473)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477545473 NPI number — DR. LOUISA POLO RAMONE M.D. , FAAP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAMONE
Provider First Name:
LOUISA
Provider Middle Name:
POLO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D. , FAAP
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:
1477545473
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/13/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/23/2006
NPI Reactivation Date:
03/28/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1516 BEVERLEY RD
Provider Second Line Business Mailing Address:
1ST FLOOR SUITE
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11226-4516
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-287-6400
Provider Business Mailing Address Fax Number:
718-287-0125

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1516 BEVERLEY RD
Provider Second Line Business Practice Location Address:
1ST FLOOR SUITE
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11226-4516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-287-6400
Provider Business Practice Location Address Fax Number:
718-287-0125
Provider Enumeration Date:
08/17/2005

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: 208000000X , with the licence number:  144776 , 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: 00647989 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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