1720083306 NPI number — DR. STEVEN P KOENIG M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720083306 NPI number — DR. STEVEN P KOENIG M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOENIG
Provider First Name:
STEVEN
Provider Middle Name:
P
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1720083306
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/20/2006
NPI Reactivation Date:
03/27/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 E 40TH ST
Provider Second Line Business Mailing Address:
RM 203
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10016-1201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-889-3550
Provider Business Mailing Address Fax Number:
212-696-1190

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 E 40TH ST
Provider Second Line Business Practice Location Address:
RM 203
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10016-1201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-889-3550
Provider Business Practice Location Address Fax Number:
212-696-1190
Provider Enumeration Date:
06/20/2005

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: 207W00000X , with the licence number:  115847 , 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: 13858 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7120687008 . This is a "CIGNA HMO AND SENIOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0013890 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0014781 . This is a "AETNA USHEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: NS3857 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4248270 . This is a "AETNA US HEALTHCARE PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 969461 . This is a "BCBS EMPIRE PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 669977 . This is a "UNITED" identifier . This identifiers is of the category "OTHER".
  • Identifier: MT0001479 . This is a "SELECTPRO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 115847 24976P . This is a "HIP" identifier . This identifiers is of the category "OTHER".




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