1639207319 NPI number — GARDEN CITY NEUROLOGY, LTD

Table of content: (NPI 1639207319)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639207319 NPI number — GARDEN CITY NEUROLOGY, LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GARDEN CITY NEUROLOGY, LTD
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:
6
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:
1639207319
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
900 RESERVOIR AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRANSTON
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02910-4417
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-714-0222
Provider Business Mailing Address Fax Number:
401-714-0220

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 RESERVOIR AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRANSTON
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02910-4417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-714-0222
Provider Business Practice Location Address Fax Number:
401-714-0220
Provider Enumeration Date:
03/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CERVONE
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
LOUIS
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
401-714-0222

Provider Taxonomy Codes

  • Taxonomy code: 2084N0600X , with the licence number:  MD10970 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 26655-2 . This is a "BLUE CROSS RI NUMBER" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 4400009 . This is a "UNITED HEALTH NUMBER" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: GC51470 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2142223 . This is a "FIRST HEALTH" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 410755 . This is a "BLUECHIP NUMBER" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com