1508906777 NPI number — METROPOLITAN NEW YORK MEDICINE & INFECTIOUS DISEASES, P.C.

Table of content: (NPI 1508906777)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508906777 NPI number — METROPOLITAN NEW YORK MEDICINE & INFECTIOUS DISEASES, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
METROPOLITAN NEW YORK MEDICINE & INFECTIOUS DISEASES, 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:
1508906777
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 351
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOBBS FERRY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10522-0351
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-338-7534
Provider Business Mailing Address Fax Number:
914-338-7537

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
337 KIMBALL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YONKERS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10704-3032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-338-7534
Provider Business Practice Location Address Fax Number:
914-338-7537
Provider Enumeration Date:
02/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BONOAN
Authorized Official First Name:
JOSE
Authorized Official Middle Name:
TADEO
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
914-338-7534

Provider Taxonomy Codes

  • Taxonomy code: 207RI0200X , with the licence number:  202436 , 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: N81758 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2512720 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2813319 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 202436 . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2X0703 . This is a "EMPIRE BLUE CROSS BLUE SH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P00033933 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P2579806 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 02957495 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com