1881667905 NPI number — IVAN PAUL RAPPAPORT M.D.

Table of content: IVAN PAUL RAPPAPORT M.D. (NPI 1881667905)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881667905 NPI number — IVAN PAUL RAPPAPORT M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAPPAPORT
Provider First Name:
IVAN
Provider Middle Name:
PAUL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RAPPAPORT
Provider Other First Name:
I
Provider Other Middle Name:
PAUL
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1881667905
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
414 MAPLE AVE
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
SARATOGA SPRINGS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12866-5550
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-587-9243
Provider Business Mailing Address Fax Number:
518-587-6836

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
414 MAPLE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SARATOGA SPRINGS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12866-5550
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-587-9243
Provider Business Practice Location Address Fax Number:
518-587-6836
Provider Enumeration Date:
02/09/2006

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: 174400000X , with the licence number:  160824 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 08U281 . This is a "EMPIRE HEALTHCHOICE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 07112 . This is a "MVP HEALTH PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 10001682 . This is a "CDPHP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000471896001 . This is a "BLUE SHIELD NORTHEASTERN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com