1558510420 NPI number — MS. CLAIRE ANITA ESSON-SAMUELS RD

Table of content: MS. CLAIRE ANITA ESSON-SAMUELS RD (NPI 1558510420)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558510420 NPI number — MS. CLAIRE ANITA ESSON-SAMUELS RD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ESSON-SAMUELS
Provider First Name:
CLAIRE
Provider Middle Name:
ANITA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RD
Provider Gender Code:
F

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:
1558510420
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
920 CO OP CITY BLVD APT 2J
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRONX
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10475-1648
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-671-0278
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18410 JAMAICA AVE
Provider Second Line Business Practice Location Address:
LIFESPIRE INC
Provider Business Practice Location Address City Name:
HOLLIS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11423-2400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-455-1941
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/15/2008

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: 133N00000X , with the licence number:  0060861 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 133V00000X , with the licence number: 894124 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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