1104832104 NPI number — DR. MICHAEL TIMOTHY STOWE PHD

Table of content: DR. MICHAEL TIMOTHY STOWE PHD (NPI 1104832104)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104832104 NPI number — DR. MICHAEL TIMOTHY STOWE PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STOWE
Provider First Name:
MICHAEL
Provider Middle Name:
TIMOTHY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
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:
1104832104
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:
625 GRAMATAN AVE
Provider Second Line Business Mailing Address:
SUITE ST-O
Provider Business Mailing Address City Name:
MOUNT VERNON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10552-1839
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-668-6621
Provider Business Mailing Address Fax Number:
914-663-4130

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
625 GRAMATAN AVE
Provider Second Line Business Practice Location Address:
SUITE ST-O
Provider Business Practice Location Address City Name:
MOUNT VERNON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10552-1839
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-668-6621
Provider Business Practice Location Address Fax Number:
914-663-4130
Provider Enumeration Date:
07/31/2006

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: 103G00000X , with the licence number:  012979 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 103TC0700X , with the licence number: 012979 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 6804423 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 012979A37 . This is a "HEALTHFIRST" identifier . This identifiers is of the category "OTHER".
  • Identifier: P12007734 . This is a "MULTIPLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 02131313 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: P2352570 . This is a "OXFORD HEALTH PLANS" identifier . This identifiers is of the category "OTHER".
  • Identifier: V161X2 . This is a "EMPIRE BLUE CROSS BLUE SH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 19286 . This is a "CARE MANAGEMENT ORGANIZAT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 55247 . This is a "HIP PAPER ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 14026595 . This is a "AFFINITY HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7694267 . This is a "AETNA US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 87726 . This is a "UNITED BEHAVIORAL HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01297968 . This is a "HIP OF NEW YORK" identifier . This identifiers is of the category "OTHER".
  • Identifier: OH2319 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2573709 . This is a "AETNA US HEALTHCARE HMO" identifier . This identifiers is of the category "OTHER".




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