1780858274 NPI number — NEW CREATION CHRISTIAN COUNSELING & PROFESSIONAL SERVICES

Table of content: (NPI 1780858274)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780858274 NPI number — NEW CREATION CHRISTIAN COUNSELING & PROFESSIONAL SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW CREATION CHRISTIAN COUNSELING & PROFESSIONAL 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:
1780858274
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 OZONE PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MASSAPEQUA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11758-6817
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-795-0009
Provider Business Mailing Address Fax Number:
516-797-8850

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 OZONE PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MASSAPEQUA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11758-6817
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-795-0009
Provider Business Practice Location Address Fax Number:
516-797-8850
Provider Enumeration Date:
04/16/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SMALLING
Authorized Official First Name:
RENE
Authorized Official Middle Name:
ALEXIA
Authorized Official Title or Position:
SECRETARY
Authorized Official Telephone Number:
516-795-0009

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  R057190 , 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: 02385546 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 127123 . This is a "VYTRA HEALTH PLANS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 370673 . This is a "HARMONY BEHAVIORAL HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 747-9139 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: N90706 . This is a "HEALTH NET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P1020668 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: R057190-A37 . This is a "HEALTH FIRST" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 269983 . This is a "MHN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 413031 . This is a "VALUE OPTIONS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7797384 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: IP573503 . This is a "MAGELLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: N5V961 . This is a "EMPIRE BC/BS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 057190-N01 . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6238574 . This is a "UBH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000530050201 . This is a "HEALTH PLUS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1826607 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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