1780042937 NPI number — COMMONWEALTH DIAGNOSTICS INC

Table of content: ALEXANDRA NICOLE PONCE ARCILLA RDN, LDN (NPI 1336737865)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780042937 NPI number — COMMONWEALTH DIAGNOSTICS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMONWEALTH DIAGNOSTICS 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:
1780042937
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/03/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1924 OCEAN AVE
Provider Second Line Business Mailing Address:
APT 2B
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11230-6719
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-562-7003
Provider Business Mailing Address Fax Number:
617-275-0851

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2270 UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
STE 1B
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10468-6265
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-562-7003
Provider Business Practice Location Address Fax Number:
617-275-0851
Provider Enumeration Date:
02/03/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TKEBUCHAVA
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
917-562-7003

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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