1720308877 NPI number — NORTHEASTERN MEDICAL HEALTH GROUP LLC.

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 1720308877 NPI number — NORTHEASTERN MEDICAL HEALTH GROUP LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHEASTERN MEDICAL HEALTH GROUP LLC.
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:
1720308877
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/10/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1189
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAJARDO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00738-1189
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-556-2725
Provider Business Mailing Address Fax Number:
787-998-9898

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AVE. GENERAL VALERO 375
Provider Second Line Business Practice Location Address:
EDIFICIO ESQUINA MEDICA SUITE 103
Provider Business Practice Location Address City Name:
FAJARDO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00738
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-556-2725
Provider Business Practice Location Address Fax Number:
787-998-9898
Provider Enumeration Date:
06/10/2010

Additional Information

Authorized Official

Authorized Official Last Name:
ROBLES PADRO
Authorized Official First Name:
VICTOR
Authorized Official Middle Name:
WILFREDO
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-556-2725

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  16707 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com