1891967626 NPI number — JESSICA LATTMAN MD PLLC

Table of content: (NPI 1891967626)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891967626 NPI number — JESSICA LATTMAN MD PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JESSICA LATTMAN MD 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:
1891967626
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
115 EAST 61 ST
Provider Second Line Business Mailing Address:
SUITE 1A
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10065-8184
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-832-5456
Provider Business Mailing Address Fax Number:
212-421-0176

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 EAST 61 ST
Provider Second Line Business Practice Location Address:
SUITE 1A
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10065-8184
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-832-5456
Provider Business Practice Location Address Fax Number:
212-421-0176
Provider Enumeration Date:
04/01/2008

Additional Information

Authorized Official

Authorized Official Last Name:
LATTMAN
Authorized Official First Name:
JESSICA
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
212-832-5456

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  NY201144 , 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: 0499796 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7343028002 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0005065597 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: P51053942 . This is a "MULTIPLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2C9341 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 92T913 . This is a "BC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 02088122 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1907314 . This is a "UNITED" identifier . This identifiers is of the category "OTHER".
  • Identifier: P1041236 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".




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