1487786331 NPI number — PLANK MEDICAL PC

Table of content: (NPI 1487786331)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487786331 NPI number — PLANK MEDICAL PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PLANK MEDICAL 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:
1487786331
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
133 E 58TH ST
Provider Second Line Business Mailing Address:
SUITE 811
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10022-1236
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-838-1500
Provider Business Mailing Address Fax Number:
212-838-1515

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
133 E 58TH ST
Provider Second Line Business Practice Location Address:
SUITE 811
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10022-1236
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-838-1500
Provider Business Practice Location Address Fax Number:
212-838-1515
Provider Enumeration Date:
03/09/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PERNA
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
CLINIC MANAGER
Authorized Official Telephone Number:
212-838-1500

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  X010423 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 204C00000X , with the licence number: 102007-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 2084N0600X , with the licence number: 102007-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 261QP2000X , with the licence number: 027967 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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