1750410759 NPI number — IRA DAVIS, MD, PLLC

Table of content: (NPI 1750410759)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750410759 NPI number — IRA DAVIS, MD, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IRA DAVIS, MD, PLLC
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:
1750410759
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/24/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
280 N CENTRAL AVE
Provider Second Line Business Mailing Address:
SUITE 114
Provider Business Mailing Address City Name:
HARTSDALE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10530-1832
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-288-0500
Provider Business Mailing Address Fax Number:
914-288-0260

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2627 HYLAN BLVD # C
Provider Second Line Business Practice Location Address:
BOX 10
Provider Business Practice Location Address City Name:
STATEN ISLAND
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10314
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-477-4022
Provider Business Practice Location Address Fax Number:
718-698-9573
Provider Enumeration Date:
03/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MANN
Authorized Official First Name:
WENDY
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLER
Authorized Official Telephone Number:
914-774-2478

Provider Taxonomy Codes

  • Taxonomy code: 207ND0101X , with the licence number:  182268 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207NS0135X , with the licence number: 182268 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: P2869871 . This is a "OXFORD ID#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 3K2111 . This is a "BC" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P00221021 . This is a "RR MCR" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: OH4223 . This is a "HEALTHNET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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