1699290288 NPI number — ARGELIA NURSE PRACTITIONER IN ADULT HEALTH PC

Table of content: (NPI 1699290288)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699290288 NPI number — ARGELIA NURSE PRACTITIONER IN ADULT HEALTH PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARGELIA NURSE PRACTITIONER IN ADULT HEALTH 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:
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:
1699290288
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
96 HURON DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAY SHORE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11706-3718
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-278-3452
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 HOWELLS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAY SHORE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11706-5351
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-278-3452
Provider Business Practice Location Address Fax Number:
631-278-3452
Provider Enumeration Date:
08/04/2017

Additional Information

Authorized Official

Authorized Official Last Name:
DIAZ
Authorized Official First Name:
ARGELIA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADULT NURSE PRACTITIONER
Authorized Official Telephone Number:
631-278-3452

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 003750083003 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 17803991 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: F306138-A85 . This is a "HEALTHFIRST" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 03784847 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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