1760148423 NPI number — MULTIPLE SCLEROSIS PRACTICE

Table of content: (NPI 1922897305)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760148423 NPI number — MULTIPLE SCLEROSIS PRACTICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MULTIPLE SCLEROSIS PRACTICE
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:
1760148423
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/16/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 E 95TH ST APT 1A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10128-0732
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
646-226-2616
Provider Business Mailing Address Fax Number:
212-426-0094

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 E 95TH ST APT 1A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10128-0732
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
646-226-2616
Provider Business Practice Location Address Fax Number:
212-426-0094
Provider Enumeration Date:
11/16/2021

Additional Information

Authorized Official

Authorized Official Last Name:
BEN-ZACHARIA
Authorized Official First Name:
ALIZA
Authorized Official Middle Name:
BITTON
Authorized Official Title or Position:
NURSE PRACTITIONER
Authorized Official Telephone Number:
646-226-2616

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 02142309 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com