1699911917 NPI number — MISS IRENE NONE MYKOLIW OTR/L

Table of content: KELLY ANN RODRIGUEZ PHD (NPI 1710380860)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699911917 NPI number — MISS IRENE NONE MYKOLIW OTR/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MYKOLIW
Provider First Name:
IRENE
Provider Middle Name:
NONE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
OTR/L
Provider Gender Code:
F

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:
1699911917
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
56 EAST 7TH ST
Provider Second Line Business Mailing Address:
APARTMENT 14
Provider Business Mailing Address City Name:
NEW YORK CITY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10003-8482
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-979-6456
Provider Business Mailing Address Fax Number:
212-979-6456

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
465 GRAND ST FL 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK CITY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10002-4800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-420-1999
Provider Business Practice Location Address Fax Number:
212-420-1910
Provider Enumeration Date:
12/17/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  004862-1 , 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)