1871552661 NPI number — DR. ELI EDWARD HENDEL MD

Table of content: DR. ELI EDWARD HENDEL MD (NPI 1871552661)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871552661 NPI number — DR. ELI EDWARD HENDEL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HENDEL
Provider First Name:
ELI
Provider Middle Name:
EDWARD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1871552661
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/26/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 16271
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ENCINO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91416-6271
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-788-6172
Provider Business Mailing Address Fax Number:
818-788-4431

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 SOUTH CENTRAL AVE
Provider Second Line Business Practice Location Address:
SUITE 117
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-500-9545
Provider Business Practice Location Address Fax Number:
818-500-7414
Provider Enumeration Date:
03/21/2006

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: 207R00000X , with the licence number:  A36257 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , with the licence number: A36257 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00A362570 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com