1710382429 NPI number — MISS CHRISTINA IREN ASZTALOS M.S.E.D

Table of content: MISS CHRISTINA IREN ASZTALOS M.S.E.D (NPI 1710382429)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710382429 NPI number — MISS CHRISTINA IREN ASZTALOS M.S.E.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ASZTALOS
Provider First Name:
CHRISTINA
Provider Middle Name:
IREN
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
M.S.E.D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ASZTALOS
Provider Other First Name:
CHRISTINA
Provider Other Middle Name:
IREN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S.E.D
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1710382429
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2554 W 16TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11214-6906
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
347-631-4139
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7000 AUSTIN ST
Provider Second Line Business Practice Location Address:
FORST HILLS SUITE 200
Provider Business Practice Location Address City Name:
FOREST HILLS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11375-1022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-762-7633
Provider Business Practice Location Address Fax Number:
718-886-8694
Provider Enumeration Date:
10/24/2014

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: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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