1871552521 NPI number — HAROLD S. ROSS, M.D., P.C.

Table of content: (NPI 1871552521)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871552521 NPI number — HAROLD S. ROSS, M.D., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAROLD S. ROSS, M.D., P.C.
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:
MASON STREET OPTICAL DIVISION
Provider Other Organization Name Type Code:
5
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:
1871552521
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
738 PRE EMPTION RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GENEVA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14456-1336
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-789-8897
Provider Business Mailing Address Fax Number:
315-781-6342

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
738 PRE EMPTION RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GENEVA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14456-1336
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-789-8897
Provider Business Practice Location Address Fax Number:
315-781-6342
Provider Enumeration Date:
03/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROSS
Authorized Official First Name:
HAROLD
Authorized Official Middle Name:
S
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
315-789-4922

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 017811937 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 017811937 . This is a "EXCELLUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9748670 . This is a "GROUP HEALTH INC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 103065CT . This is a "PREFERRED CARE" identifier . This identifiers is of the category "OTHER".




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