1760884134 NPI number — ALVIN N EDEN PEDIATRICS

Table of content: (NPI 1760884134)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760884134 NPI number — ALVIN N EDEN PEDIATRICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALVIN N EDEN PEDIATRICS
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:
1760884134
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/17/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10721 QUEENS BLVD
Provider Second Line Business Mailing Address:
SUITE 7
Provider Business Mailing Address City Name:
FOREST HILLS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11375-4413
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-261-8989
Provider Business Mailing Address Fax Number:
718-261-8995

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10721 QUEENS BLVD
Provider Second Line Business Practice Location Address:
SUITE 7
Provider Business Practice Location Address City Name:
FOREST HILLS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11375-4413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-261-8989
Provider Business Practice Location Address Fax Number:
718-261-8995
Provider Enumeration Date:
09/17/2014

Additional Information

Authorized Official

Authorized Official Last Name:
EDEN
Authorized Official First Name:
ALVIN
Authorized Official Middle Name:
N
Authorized Official Title or Position:
PEDIATRICIAN
Authorized Official Telephone Number:
718-261-8989

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  074400 , 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: 000024001 . This is a "AMERIGROUP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00986910 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 313440101 . This is a "HEALTH PLUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 313350101 . This is a "HEALTH PLUS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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