1962483321 NPI number — FRANK M BONE DDS

Table of content: FRANK M BONE DDS (NPI 1962483321)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962483321 NPI number — FRANK M BONE DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BONE
Provider First Name:
FRANK
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DDS
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:
1962483321
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1670 PUTNAM AVE
Provider Second Line Business Mailing Address:
STE 1R
Provider Business Mailing Address City Name:
RIDGEWOOD
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11385-3449
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-366-3700
Provider Business Mailing Address Fax Number:
718-366-6999

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1670 PUTNAM AVE
Provider Second Line Business Practice Location Address:
STE 1R
Provider Business Practice Location Address City Name:
RIDGEWOOD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11385-3449
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-366-3700
Provider Business Practice Location Address Fax Number:
718-366-6999
Provider Enumeration Date:
11/10/2005

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: 122300000X , with the licence number:  OA9255 1 , 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: 02228031 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com