1790531440 NPI number — DR. GERALDINE KORDAI MOULD M.D

Table of content: DR. GERALDINE KORDAI MOULD M.D (NPI 1790531440)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790531440 NPI number — DR. GERALDINE KORDAI MOULD M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOULD
Provider First Name:
GERALDINE
Provider Middle Name:
KORDAI
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MOULD
Provider Other First Name:
KORDAI
Provider Other Middle Name:
GERALDINE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1790531440
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/03/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
506 LENOX AVENUE
Provider Second Line Business Mailing Address:
RM-13-106-MLK
Provider Business Mailing Address City Name:
HARLEM
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10037
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-939-1406
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
506 LENOX AVENUE
Provider Second Line Business Practice Location Address:
RM-13-106-MLK
Provider Business Practice Location Address City Name:
HARLEM
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-939-1406
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/24/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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