1588654636 NPI number — UNIVERSITY ORTHOPEDICS OF NEW YORK PLLC

Table of content: (NPI 1588654636)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588654636 NPI number — UNIVERSITY ORTHOPEDICS OF NEW YORK PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY ORTHOPEDICS OF NEW YORK PLLC
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:
1588654636
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2318 31ST ST
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
ASTORIA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11105-2892
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-777-1885
Provider Business Mailing Address Fax Number:
718-777-9613

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2318 31ST ST
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
ASTORIA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11105-2892
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-777-1885
Provider Business Practice Location Address Fax Number:
718-777-9613
Provider Enumeration Date:
10/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
TECZA
Authorized Official First Name:
MARTA
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
718-777-1885

Provider Taxonomy Codes

  • Taxonomy code: 207XX0005X , with the licence number:  192054 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X , with the licence number: 192054 , 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: WEN041 . This is a "EMPIRE MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: WEN042 . This is a "EMPIRE MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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