1841531795 NPI number — FPA HOSPITAL BASED

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841531795 NPI number — FPA HOSPITAL BASED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FPA HOSPITAL BASED
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:
MOUNT SINAI DERMATOPATHOLOGY SERVICES III
Provider Other Organization Name Type Code:
3
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:
1841531795
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1468 MADISON AVE
Provider Second Line Business Mailing Address:
ANNENBERG 03-08
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10029-6508
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-241-6064
Provider Business Mailing Address Fax Number:
212-241-7832

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1468 MADISON AVE
Provider Second Line Business Practice Location Address:
ANNENBERG 03-08
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10029-6508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-731-7772
Provider Business Practice Location Address Fax Number:
212-534-7491
Provider Enumeration Date:
03/01/2013

Additional Information

Authorized Official

Authorized Official Last Name:
MACNEILL
Authorized Official First Name:
CRYSTAL
Authorized Official Middle Name:
Authorized Official Title or Position:
VP, CBO DIRECTOR
Authorized Official Telephone Number:
212-241-6228

Provider Taxonomy Codes

  • Taxonomy code: 207ZD0900X , with the licence number:  CLIA 33D1051889 , 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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