1720162431 NPI number — DR. THERESA LOSCALZO BACARIS OD

Table of content: DR. THERESA LOSCALZO BACARIS OD (NPI 1720162431)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720162431 NPI number — DR. THERESA LOSCALZO BACARIS OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BACARIS
Provider First Name:
THERESA
Provider Middle Name:
LOSCALZO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
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:
1720162431
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/01/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1360 MONTAUK HWY
Provider Second Line Business Mailing Address:
STE 2E
Provider Business Mailing Address City Name:
MASTIC
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11950-2929
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-281-2474
Provider Business Mailing Address Fax Number:
631-281-2476

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1360 MONTAUK HWY
Provider Second Line Business Practice Location Address:
STE 2E
Provider Business Practice Location Address City Name:
MASTIC
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11950-2929
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-281-2474
Provider Business Practice Location Address Fax Number:
631-281-2476
Provider Enumeration Date:
10/25/2006

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: 152W00000X , with the licence number:  VUT004799-1 , 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)

  • Identifier: 26993 . This is a "SPECTERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 34416 . This is a "AVESIS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 201972162 . This is a "NVA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2136929 . This is a "VYTRA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 201972162 . This is a "COMP BENEFITS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 201972162 . This is a "HORIZON HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6599195 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 921377 . This is a "BLOCK VISION" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: NY0047 . This is a "EYEMED" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 198546P . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 201972162 . This is a "ISLAND GROUP ADMINISTATOR" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P3548978 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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