1801056619 NPI number — STEVEN A. ODRICH,MD, MARC G. ODRICH, MD, PC

Table of content: (NPI 1801056619)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801056619 NPI number — STEVEN A. ODRICH,MD, MARC G. ODRICH, MD, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STEVEN A. ODRICH,MD, MARC G. ODRICH, MD, PC
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:
1801056619
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/02/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3765 RIVERDALE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRONX
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10463-1845
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-432-2020
Provider Business Mailing Address Fax Number:
718-432-8482

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3765 RIVERDALE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10463-1845
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-432-2020
Provider Business Practice Location Address Fax Number:
718-432-8482
Provider Enumeration Date:
06/16/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HATTASCH
Authorized Official First Name:
FLORENCE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
718-432-2020

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  163491 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , with the licence number: 179385 , 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: 000B21 . This is a "BLUE CROSS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7934148 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P452672 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01783462 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01444600 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1120632 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0052450 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: GS278 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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