1952441420 NPI number — IYAR MEDICAL PC

Table of content: (NPI 1952441420)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952441420 NPI number — IYAR MEDICAL PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IYAR MEDICAL PC
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:
1952441420
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/14/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7235 112TH ST
Provider Second Line Business Mailing Address:
SUITE # PR9,
Provider Business Mailing Address City Name:
FOREST HILLS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11375-5469
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-849-4917
Provider Business Mailing Address Fax Number:
877-949-4917

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7235 112TH ST
Provider Second Line Business Practice Location Address:
SUITE # PR9,
Provider Business Practice Location Address City Name:
FOREST HILLS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11375-5469
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-849-4917
Provider Business Practice Location Address Fax Number:
877-949-4917
Provider Enumeration Date:
02/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LAGODUKE
Authorized Official First Name:
NIKOLAI
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
877-849-4917

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  030904 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 233906 , 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: 000399390201 . This is a "HEALTHPLUS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 179953 . This is a "ELDERPLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 268SV1 . This is a "EMPIRE BLUE CROSS AND BLU" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P3725574 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: PCP ID# 5416260001 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02619565 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000119919 . This is a "GHI HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00002513975 09 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 11P12182 . This is a "NY PRESBYTERIAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 233906 . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6C5025 . This is a "HEALTHNET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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