1841410925 NPI number — DR. LINCOLN MATHER CLEVELAND MD

Table of content: DR. LINCOLN MATHER CLEVELAND MD (NPI 1841410925)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841410925 NPI number — DR. LINCOLN MATHER CLEVELAND MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CLEVELAND
Provider First Name:
LINCOLN
Provider Middle Name:
MATHER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1841410925
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/16/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
175 W 73RD ST APT 10F
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10023-2933
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-362-6496
Provider Business Mailing Address Fax Number:
212-362-6496

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
70 PINE STREET
Provider Second Line Business Practice Location Address:
26TH FLOOR AIG MEDICAL DEPT
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10270
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-770-5117
Provider Business Practice Location Address Fax Number:
212-825-5127
Provider Enumeration Date:
04/30/2007

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: 207P00000X , with the licence number:  174466 , 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)





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