1881765139 NPI number — BROADWAY CARDIOPULMONARY, P.C.

Table of content: (NPI 1881765139)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881765139 NPI number — BROADWAY CARDIOPULMONARY, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BROADWAY CARDIOPULMONARY, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1881765139
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 E 59TH ST
Provider Second Line Business Mailing Address:
SUITE 10B
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10022-1304
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-407-3950
Provider Business Mailing Address Fax Number:
212-583-2961

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 E 59TH ST
Provider Second Line Business Practice Location Address:
SUITE 10B
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10022-1304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-407-3950
Provider Business Practice Location Address Fax Number:
212-583-2961
Provider Enumeration Date:
11/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ATALLAH-LAJAM
Authorized Official First Name:
FARAH
Authorized Official Middle Name:
Authorized Official Title or Position:
TREASURER
Authorized Official Telephone Number:
212-407-3950

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  60-22603 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207UN0901X , with the licence number: 60-22603 , 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)





Copyright © 2007-2025 www.npivalidator.com