Basic Information
Provider Information | |||||||||
NPI: | 1629036751 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | NEW YORK DOWNTOWN HOSPITAL FPP | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | NYDH EMERGENCY SERVICES | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 10309 | ||||||||
Address2: | NYDH EMERGENCY SERVICES | ||||||||
City: | UNIONDALE | ||||||||
State: | NY | ||||||||
PostalCode: | 115550309 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 1904805115 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 170 WILLIAM ST | ||||||||
Address2: | NEW YORK DOWNTOWN HOSPITAL | ||||||||
City: | NEW YORK | ||||||||
State: | NY | ||||||||
PostalCode: | 100382612 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2123125068 | ||||||||
FaxNumber: | 2123125985 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/01/2006 | ||||||||
LastUpdateDate: | 11/05/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | DAJER | ||||||||
AuthorizedOfficialFirstName: | ANTONIO | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | CHAIR ED | ||||||||
AuthorizedOfficialTelephone: | 2123125068 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | MD | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X |   | NY | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |   |
No ID Information.