1740217108 NPI number — RAYMOND J. NISI,MD,PC

Table of content: (NPI 1740217108)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740217108 NPI number — RAYMOND J. NISI,MD,PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RAYMOND J. NISI,MD,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:
6
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:
1740217108
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 WATERS PL
Provider Second Line Business Mailing Address:
SUITE M101
Provider Business Mailing Address City Name:
BRONX
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10461-2728
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-904-9000
Provider Business Mailing Address Fax Number:
718-904-8610

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 WATERS PLACE
Provider Second Line Business Practice Location Address:
SUITE M101 / NORTH LOBBY
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10461-2729
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-904-9000
Provider Business Practice Location Address Fax Number:
718-904-8610
Provider Enumeration Date:
06/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TORRES
Authorized Official First Name:
ALLAN
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
ADMINISTRATING MANAGER
Authorized Official Telephone Number:
718-904-9000

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  183813 , 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: 01851289 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com