1851455885 NPI number — BRONX LEBANON NEPHROLOGY, PLLC

Table of content: (NPI 1851455885)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851455885 NPI number — BRONX LEBANON NEPHROLOGY, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRONX LEBANON NEPHROLOGY, PLLC
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:
1851455885
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/07/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/28/2012
NPI Reactivation Date:
05/01/2012

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 260
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IRVINGTON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10533-0260
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-518-5232
Provider Business Mailing Address Fax Number:
718-518-5636

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1650 SELWYN AVE
Provider Second Line Business Practice Location Address:
8-G
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10457-7626
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-518-5232
Provider Business Practice Location Address Fax Number:
718-518-5636
Provider Enumeration Date:
12/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
UDAY
Authorized Official First Name:
KALPANA
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER/PARTNER
Authorized Official Telephone Number:
718-518-5232

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  255628 , 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: 03347266 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1144391251 . This is a "NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00436677 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01404737 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1043263882 . This is a "NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 02738810 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1689833303 . This is a "NPI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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