1487928693 NPI number — ADIL H AL-HUMADI, P.C.

Table of content: (NPI 1487928693)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487928693 NPI number — ADIL H AL-HUMADI, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADIL H AL-HUMADI, P.C.
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:
1487928693
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2223 W STATE ST
Provider Second Line Business Mailing Address:
SUITE 117
Provider Business Mailing Address City Name:
OLEAN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14760-1938
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-372-9629
Provider Business Mailing Address Fax Number:
716-372-9638

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2223 W STATE ST
Provider Second Line Business Practice Location Address:
SUITE 117
Provider Business Practice Location Address City Name:
OLEAN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14760-1938
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-372-9629
Provider Business Practice Location Address Fax Number:
716-372-9638
Provider Enumeration Date:
03/06/2012

Additional Information

Authorized Official

Authorized Official Last Name:
AL-HUMADI
Authorized Official First Name:
ADIL
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
716-372-9629

Provider Taxonomy Codes

  • Taxonomy code: 208C00000X , with the licence number:  120097-1 , 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: 001304052 . This is a "BLUE SHIELD OF PA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 00604480 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 283015003 . This is a "TRAVELERS MEDICAER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1401542 . This is a "INDEPENDENT HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00010001801 . This is a "UNIVERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000506398001 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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