1558798850 NPI number — PETIA TRIFONOVA PAPAZOGLOU NURSE PRACTITIONAL

Table of content: PETIA TRIFONOVA PAPAZOGLOU NURSE PRACTITIONAL (NPI 1558798850)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558798850 NPI number — PETIA TRIFONOVA PAPAZOGLOU NURSE PRACTITIONAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PAPAZOGLOU
Provider First Name:
PETIA
Provider Middle Name:
TRIFONOVA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NURSE PRACTITIONAL
Provider Gender Code:
F

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:
1558798850
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/01/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7620 BAY PKWY
Provider Second Line Business Mailing Address:
SUITE 1B
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11214
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-361-4120
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7620 BAY PKWY
Provider Second Line Business Practice Location Address:
SUITE 1B
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11214-1532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-232-1492
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/01/2013

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: 363LP0808X , with the licence number:  401650 , 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)





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