Healthcare Provider Details

I. General information

NPI: 1033237995
Provider Name (Legal Business Name): PAUL FOX
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 10/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NSUH AT PLAINVIEW-DEPT OF EMERGENCY SERVICES 888 OLD COUNTRY ROAD
PLAINVIEW NY
11803
US

IV. Provider business mailing address

NSUH AT PLAINVIEW-DEPT OF EMERGENCY SERVICES 888 OLD COUNTRY ROAD
PLAINVIEW NY
11803
US

V. Phone/Fax

Practice location:
  • Phone: 516-719-2336
  • Fax:
Mailing address:
  • Phone: 516-719-2336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number205081
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier01822408
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: