1487102414 NPI number — ST. ANTHONY MEDICAL SERVICES, PC

Table of content: (NPI 1487102414)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487102414 NPI number — ST. ANTHONY MEDICAL SERVICES, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. ANTHONY MEDICAL SERVICES, PC
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:
1487102414
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
445 77TH STREET
Provider Second Line Business Mailing Address:
1ST FLOOR
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11209-0000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
347-678-1225
Provider Business Mailing Address Fax Number:
718-833-9164

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
470 77TH ST
Provider Second Line Business Practice Location Address:
1ST FLOOR
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11209-3206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-678-1225
Provider Business Practice Location Address Fax Number:
718-833-9164
Provider Enumeration Date:
09/20/2016

Additional Information

Authorized Official

Authorized Official Last Name:
EL-KHOURY
Authorized Official First Name:
NICOLAS
Authorized Official Middle Name:
G.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
347-678-1225

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , with the licence number:  179509 , 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)





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