1629066949 NPI number — SALIL P MARFATIA MD PC

Table of content: (NPI 1629066949)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629066949 NPI number — SALIL P MARFATIA MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SALIL P MARFATIA MD PC
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:
1629066949
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/30/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8625 EDGERTON BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JAMAICA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11432-2936
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-298-6575
Provider Business Mailing Address Fax Number:
718-657-1224

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9229 QUEENS BLVD
Provider Second Line Business Practice Location Address:
SUITE 1-A
Provider Business Practice Location Address City Name:
REGO PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11374-1056
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-897-5700
Provider Business Practice Location Address Fax Number:
718-897-2087
Provider Enumeration Date:
10/11/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MARFATIA
Authorized Official First Name:
SALIL
Authorized Official Middle Name:
P
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
718-897-5700

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  185108 , 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: 01366930 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2503394 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 006AS1 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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