1629593892 NPI number — ANTOINETTE CAVALENES JOYCE

Table of content: (NPI 1629593892)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629593892 NPI number — ANTOINETTE CAVALENES JOYCE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANTOINETTE CAVALENES JOYCE
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:
1629593892
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/17/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14 COLONIAL CT
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:
10310-2806
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-442-2394
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
290 GARRETSON 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:
10305-1236
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-698-3222
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/09/2017

Additional Information

Authorized Official

Authorized Official Last Name:
CAVALENES JOYCE
Authorized Official First Name:
ANTOINETTE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
718-698-3222

Provider Taxonomy Codes

  • Taxonomy code: 261QM0850X , with the licence number:  R036109-1 , 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: 254974 . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2824155000 . This is a "AMERIHEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7483237 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5623681 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 817451 . This is a "WELLCARE OF NY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 053476000 . This is a "MAGELLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 108633 . This is a "MHN" identifier . This identifiers is of the category "OTHER".
  • Identifier: N76411 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: CA6109 . This is a "ATLANTIS" identifier . This identifiers is of the category "OTHER".
  • Identifier: N76412 . This is a "EMPIRE BLUE CROSS AND BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: SEIU135526 . This is a "1199SEIU" identifier . This identifiers is of the category "OTHER".




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