1528139466 NPI number — DR. WILLIAM ANTHONY LAFFERTY DPM

Table of content: DR. WILLIAM ANTHONY LAFFERTY DPM (NPI 1528139466)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528139466 NPI number — DR. WILLIAM ANTHONY LAFFERTY DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAFFERTY
Provider First Name:
WILLIAM
Provider Middle Name:
ANTHONY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

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:
1528139466
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/22/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
250 PARKWOOD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STATEN ISLAND
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10309-2242
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-351-0786
Provider Business Mailing Address Fax Number:
718-351-3983

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
175 GUYON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STATEN ISLAND
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10306-3947
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-351-0786
Provider Business Practice Location Address Fax Number:
718-351-3983
Provider Enumeration Date:
11/13/2006

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: 213ES0103X , with the licence number:  N005596 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 213ES0103X , with the licence number: 25MD00259300 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1499659 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7862397 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: N0U231 . This is a "BLUE CROSS PPO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P2650586 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: PG9311 . This is a "BLUE CROSS HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2223930 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 370013065 . This is a "CHILD HEALTH PLUS" identifier . This identifiers is of the category "OTHER".




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