1659494094 NPI number — COMMUNITY CARE PHYSICIANS, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659494094 NPI number — COMMUNITY CARE PHYSICIANS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY CARE PHYSICIANS, 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:
COMMUNITY CARE OB/GYN & MIDWIFERY
Provider Other Organization Name Type Code:
3
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:
1659494094
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/14/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6 WELLNESS WAY STE 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LATHAM
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12110-2156
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-782-3700
Provider Business Mailing Address Fax Number:
518-782-3799

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6 WELLNESS WAY STE 108
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LATHAM
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12110-2156
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-370-7937
Provider Business Practice Location Address Fax Number:
518-377-2983
Provider Enumeration Date:
04/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PARIKH
Authorized Official First Name:
SHIRISH
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
518-213-0478

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1053471730 . This is a "DR. SATTAR NPI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 12059825058 . This is a "CAREN CROOTOF, CNM NPI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02335220 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1780764704 . This is a "REBECCA ESKIN CNM NPI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1053471755 . This is a "JAIME NASS, CNM NPI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1205996998 . This is a "DR. KERNER NPI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00743302 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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