1497216675 NPI number — R & V NP IN PSYCHIATRIC SERVICES PLLC

Table of content: (NPI 1497216675)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497216675 NPI number — R & V NP IN PSYCHIATRIC SERVICES PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
R & V NP IN PSYCHIATRIC SERVICES PLLC
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:
1497216675
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/24/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1850 LAFAYETTE AVE APT 6E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRONX
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10473-2837
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
646-844-0518
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
340 TRINITY PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MALVERNE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11565-1248
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-557-6064
Provider Business Practice Location Address Fax Number:
917-591-4505
Provider Enumeration Date:
03/28/2019

Additional Information

Authorized Official

Authorized Official Last Name:
ANUSIONWU
Authorized Official First Name:
REAGAN
Authorized Official Middle Name:
Authorized Official Title or Position:
FOUNDER
Authorized Official Telephone Number:
718-309-0381

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 03623232 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com