Basic Information
Provider Information | |||||||||
NPI: | 1013344571 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | CITY OF NY OFFICE OF PAYROLL ADM C/O OFFICE OF PAYROLL ADMIN | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | NYC DEPT. OF HEALTH AND MENTAL HYGIENE | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 4209 28TH ST | ||||||||
Address2: |   | ||||||||
City: | LONG ISLAND CITY | ||||||||
State: | NY | ||||||||
PostalCode: | 111014130 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3473966234 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 4209 28TH ST | ||||||||
Address2: |   | ||||||||
City: | LONG ISLAND CITY | ||||||||
State: | NY | ||||||||
PostalCode: | 111014130 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3473966234 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/30/2013 | ||||||||
LastUpdateDate: | 09/30/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | FARLEY | ||||||||
AuthorizedOfficialFirstName: | THOMAS | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | COMMISSIONER | ||||||||
AuthorizedOfficialTelephone: | 3473964100 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | DR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | MD | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 395611 | NY | Y | 193200000X MULTI-SPECIALTY GROUP | Nursing Service Providers | Registered Nurse |   |
No ID Information.