1952757833 NPI number — AVONDALE CARE GROUP LLC

Table of content: (NPI 1952757833)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952757833 NPI number — AVONDALE CARE GROUP LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AVONDALE CARE GROUP LLC
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:
1952757833
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/26/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
505 8TH AVE
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10018
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
646-741-7979
Provider Business Mailing Address Fax Number:
646-727-4689

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
505 8TH AVE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10018-6505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
646-741-7979
Provider Business Practice Location Address Fax Number:
646-727-4689
Provider Enumeration Date:
05/10/2016

Additional Information

Authorized Official

Authorized Official Last Name:
VIAR
Authorized Official First Name:
PHILIP
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
646-741-7979

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  1625L001 , 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: 04241618 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com