1841568870 NPI number — PETER M ODELL MD PC

Table of content: (NPI 1841568870)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841568870 NPI number — PETER M ODELL MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PETER M ODELL 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:
1841568870
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/03/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
53 EAST 70TH STREET
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:
10021
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-288-8025
Provider Business Mailing Address Fax Number:
212-288-8095

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
53 E 70TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10021-4986
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-288-8025
Provider Business Practice Location Address Fax Number:
212-288-8095
Provider Enumeration Date:
12/05/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ODELL
Authorized Official First Name:
PETER
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRERSIDENT
Authorized Official Telephone Number:
212-288-8025

Provider Taxonomy Codes

  • Taxonomy code: 261QS0132X , with the licence number:  109269 , 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)