1902128648 NPI number — NORTH EAST MEDICAL SERVICES

Table of content: (NPI 1902128648)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902128648 NPI number — NORTH EAST MEDICAL SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH EAST MEDICAL SERVICES
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:
1902128648
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1520 STOCKTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94133-3354
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-391-9686
Provider Business Mailing Address Fax Number:
415-391-9704

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 NORIEGA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94122-4432
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-391-9686
Provider Business Practice Location Address Fax Number:
415-242-1781
Provider Enumeration Date:
02/23/2010

Additional Information

Authorized Official

Authorized Official Last Name:
CHAN
Authorized Official First Name:
EDDIE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
415-391-9686

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  50178 , 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: 2123667 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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