1780332973 NPI number — ONE ENDO SUPPORT SERVICES

Table of content: (NPI 1780332973)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780332973 NPI number — ONE ENDO SUPPORT SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ONE ENDO SUPPORT SERVICES
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:
1780332973
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/16/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
515 HALSTEAD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAMARONECK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10543-2715
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-777-9465
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
515 HALSTEAD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAMARONECK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10543-2715
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-777-9465
Provider Business Practice Location Address Fax Number:
914-777-9467
Provider Enumeration Date:
03/16/2022

Additional Information

Authorized Official

Authorized Official Last Name:
MICELI
Authorized Official First Name:
LORI
Authorized Official Middle Name:
Authorized Official Title or Position:
INSURANCE COORDINATOR
Authorized Official Telephone Number:
914-777-9465

Provider Taxonomy Codes

  • Taxonomy code: 1223E0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 12538 . This is a "ENDODONTICS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 1326131236 . This is a "ENDODONTICS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 059156 . This is a "ENDODONTICS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 060253 . This is a "ENDODONTICS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 049672 . This is a "ENDODONTICS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 059403 . This is a "ENDODONTICS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 12542 . This is a "ENDODONTICS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 1023471372 . This is a "ENDODONTICS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1114459328 . This is a "ENDODONTICS" identifier . This identifiers is of the category "OTHER".




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