1538454962 NPI number — LUBA NAKHUTINA COMPREHENSIVE PSYCHOLOGY SERVICES P.C.

Table of content: (NPI 1538454962)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538454962 NPI number — LUBA NAKHUTINA COMPREHENSIVE PSYCHOLOGY SERVICES P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LUBA NAKHUTINA COMPREHENSIVE PSYCHOLOGY SERVICES 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:
1538454962
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/12/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
ONE GRAND CENTRAL PLACE
Provider Second Line Business Mailing Address:
305 MADISON AVENUE, SUITE 1060
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10165
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-470-1336
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
305 MADISON AVE STE 1060
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10165-1060
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-470-1336
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/14/2011

Additional Information

Authorized Official

Authorized Official Last Name:
NAKHUTINA
Authorized Official First Name:
LUBA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
917-470-1336

Provider Taxonomy Codes

  • Taxonomy code: 103G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TB0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TF0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TH0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TM1800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TR0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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