1942684956 NPI number — MR. YOSEF SEEWALD

Table of content: MR. YOSEF SEEWALD (NPI 1942684956)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942684956 NPI number — MR. YOSEF SEEWALD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEEWALD
Provider First Name:
YOSEF
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

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:
1942684956
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/27/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26 FIREMANS MEMORIAL DRIVE
Provider Second Line Business Mailing Address:
SUITE 115
Provider Business Mailing Address City Name:
POMONA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10970
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-750-8616
Provider Business Mailing Address Fax Number:
845-362-8474

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2520 KINGS HWY
Provider Second Line Business Practice Location Address:
APT 2C
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11229-1766
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-921-6280
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/20/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  018860 , 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: 109029400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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