1487919064 NPI number — MS. GERALDINE MOISE BEAUVIL MS, TSHH

Table of content: MS. GERALDINE MOISE BEAUVIL MS, TSHH (NPI 1487919064)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487919064 NPI number — MS. GERALDINE MOISE BEAUVIL MS, TSHH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEAUVIL
Provider First Name:
GERALDINE
Provider Middle Name:
MOISE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MS, TSHH
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:
1487919064
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1050 OCEAN AVE
Provider Second Line Business Mailing Address:
A31
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11226-7477
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-294-4892
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1050 OCEAN AVE
Provider Second Line Business Practice Location Address:
A31
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11226-7477
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-294-4892
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/10/2012

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: 2355S0801X , 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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