1982725024 NPI number — DR. NATALIA ANCHIPOLOVSKY DO

Table of content: DR. NATALIA ANCHIPOLOVSKY DO (NPI 1982725024)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982725024 NPI number — DR. NATALIA ANCHIPOLOVSKY DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANCHIPOLOVSKY
Provider First Name:
NATALIA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ANCHIPOLOVSKAYA
Provider Other First Name:
NATALIYA
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DO
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1982725024
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
119 GORDON CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORADELL
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07649-2415
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-967-1928
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
77 PROSPECT AVE
Provider Second Line Business Practice Location Address:
1K
Provider Business Practice Location Address City Name:
HACKENSACK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07601-1913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-820-3596
Provider Business Practice Location Address Fax Number:
201-322-2170
Provider Enumeration Date:
04/03/2007

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: 207RE0101X , with the licence number:  25MB07834800 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 65-1262400 . This is a "TAX ID" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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