1710040779 NPI number — MR. DAVID DELROY PRICE LCSWR

Table of content: MR. DAVID DELROY PRICE LCSWR (NPI 1710040779)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710040779 NPI number — MR. DAVID DELROY PRICE LCSWR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRICE
Provider First Name:
DAVID
Provider Middle Name:
DELROY
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LCSWR
Provider Gender Code:
M

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:
1710040779
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8320 141ST ST APT 4E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JAMAICA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11435-1615
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
171-884-9797
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11021 73RD RD APT 1J SUITE 3
Provider Second Line Business Practice Location Address:
QUEENS
Provider Business Practice Location Address City Name:
FOREST HILLS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11375-6369
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
171-841-5150
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/19/2006

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: 1041C0700X , with the licence number:  R061140-1 , 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)