1497941108 NPI number — SPANISH AMERICAN FOOT ASSOCIATES PC

Table of content: (NPI 1497941108)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497941108 NPI number — SPANISH AMERICAN FOOT ASSOCIATES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPANISH AMERICAN FOOT ASSOCIATES 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:
1497941108
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/14/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3741 91ST ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSON HEIGHTS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11372-7927
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-779-3900
Provider Business Mailing Address Fax Number:
718-779-1514

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3741 91ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSON HEIGHTS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11372-7927
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-779-3900
Provider Business Practice Location Address Fax Number:
718-779-1514
Provider Enumeration Date:
09/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ANARELLA
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
718-779-3900

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  N004050 , 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: 01012413 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10200066 . This is a "AMERIGROUP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 4838990001 . This is a "DME" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P06331 . This is a "BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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