NPI |
1982946877 |
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number. |
Entity Type Code |
2 |
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number. |
Employer Identification Number EIN |
|
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified. |
Provider Organization Name Legal Business Name |
FOREST HILLS MEDICAL & DIAGNOSTIC |
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified. |
Provider First Line Business Practice Location Address |
1735 PITKIN AVE |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider Business Practice Location Address City Name |
BROOKLYN |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider Business Practice Location Address State Name |
NY |
The State code in the location of the provider
being identified. |
Provider Business Practice Location Address Postal Code |
112126603 |
The State code in the location of the provider
being identified. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The country code in the location address of the provider being identified. |
Provider Business Practice Location Address Telephone Number |
7185766647 |
The telephone number associated with the location address of the provider being identified. |
Provider Business Practice Location Address Fax Number |
7185766648 |
The fax number associated with the location
address of the provider being identified. |
Provider Enumeration Date |
3/19/2013 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Last Update Date |
3/19/2013 |
The date that a record was last updated or changed. |
Authorized Official Last Name |
OPAM |
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider. |
Authorized Official First Name |
OSAFRADU |
The first name of the authorized official. |
Authorized Official Title or Position |
PRESIDENT |
The first name of the authorized official. |
Authorized Official Telephone Number |
7185766647 |
The 10-position telephone number of the authorized official. |
Healthcare Provider Taxonomy Code 1 |
261QM1300X |
The 10-position telephone number of the authorized official. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
Is Organization Subpart |
N |
|
Authorized Official Credential Text |
MD |
|