1891813085 NPI number — PALATNIK MEDICAL CORPORATION

Table of content: (NPI 1891813085)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891813085 NPI number — PALATNIK MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PALATNIK MEDICAL CORPORATION
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:
6
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:
1891813085
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
701 HOWE AVENUE
Provider Second Line Business Mailing Address:
STE C5
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95825
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-972-1115
Provider Business Mailing Address Fax Number:
916-303-7408

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 HOWE AVE
Provider Second Line Business Practice Location Address:
STE C5
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95825-4670
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-972-1115
Provider Business Practice Location Address Fax Number:
916-303-7408
Provider Enumeration Date:
03/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PALATNIK
Authorized Official First Name:
MIKHAIL
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
916-334-1100

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  C51374 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: G01415 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZ27543Z . This is a "MEDICARE GROUP" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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