1710286208 NPI number — AVI PANDEY, M.D., PC.

Table of content: (NPI 1710286208)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710286208 NPI number — AVI PANDEY, M.D., PC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AVI PANDEY, M.D., 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:
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:
1710286208
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/23/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8045 SURREY PL
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:
11432-1450
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-454-1040
Provider Business Mailing Address Fax Number:
718-454-7992

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6118 190TH ST
Provider Second Line Business Practice Location Address:
SUITE 229
Provider Business Practice Location Address City Name:
FRESH MEADOWS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11365-2723
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-454-1040
Provider Business Practice Location Address Fax Number:
718-454-7992
Provider Enumeration Date:
03/23/2011

Additional Information

Authorized Official

Authorized Official Last Name:
PANDEY
Authorized Official First Name:
AVI
Authorized Official Middle Name:
K
Authorized Official Title or Position:
MEDICAL DOCTOR
Authorized Official Telephone Number:
718-454-1040

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  171605 , 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)

  • Identifier: 1114040 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 171605A71 . This is a "HEALTHFIRST MEDICAID" identifier . This identifiers is of the category "OTHER".
  • Identifier: DS459 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0C8079 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 513607 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01457221 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 36E363 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0006748 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 159853 . This is a "ELDERPLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 36E361 . This is a "EMPIRE MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0801348 . This is a "UNITED MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 180018329 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3938872 . This is a "1199 NATIONAL BENEFIT" identifier . This identifiers is of the category "OTHER".




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