=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255669065
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GOTHAM CITY MEDICAL BILING SERVICESS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/07/2009
-----------------------------------------------------
Last Update Date | 12/07/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 150 GREAVES LN STE L SUITE 360
-----------------------------------------------------
City | STATEN ISLAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10308-2173
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-789-3456
-----------------------------------------------------
Fax | 888-603-9061
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 150-L GREAVES LANE SUITE 360
-----------------------------------------------------
City | STATEN ISLAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-789-3456
-----------------------------------------------------
Fax | 888-603-9061
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. ROBERT HAGERMAN
-----------------------------------------------------
Credential | REGISTERED NURSE
-----------------------------------------------------
Telephone | 646-789-3456
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251X00000X
-----------------------------------------------------
Taxonomy Name | Supports Brokerage Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------