1740629062 NPI number — TAKE CONTROL OF YOUR HEALTH INC.

Table of content: (NPI 1740629062)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740629062 NPI number — TAKE CONTROL OF YOUR HEALTH INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TAKE CONTROL OF YOUR HEALTH INC.
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:
1740629062
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/11/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1416 ACKERSON BLVD
Provider Second Line Business Mailing Address:
PO BOX 1248
Provider Business Mailing Address City Name:
BAY SHORE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11706-3845
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-463-3747
Provider Business Mailing Address Fax Number:
631-968-2401

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1416 ACKERSON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAY SHORE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11706-3845
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-463-3747
Provider Business Practice Location Address Fax Number:
631-968-2401
Provider Enumeration Date:
06/19/2013

Additional Information

Authorized Official

Authorized Official Last Name:
KRONEMBERG
Authorized Official First Name:
JANET
Authorized Official Middle Name:
Authorized Official Title or Position:
REGISTER VASCULAR SPECIALIST
Authorized Official Telephone Number:
631-463-3747

Provider Taxonomy Codes

  • Taxonomy code: 305S00000X , with the licence number:  00081464 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 335V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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