=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396146221
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CITY OF NY OFFICE OF PAYROLL ADM C/O OFFICE OF PAYROLL ADMIN
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/10/2014
-----------------------------------------------------
Last Update Date | 09/10/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4209 28TH ST
-----------------------------------------------------
City | LONG ISLAND CITY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11101-4130
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-396-6234
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4209 28TH ST
-----------------------------------------------------
City | LONG ISLAND CITY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11101-4130
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-396-6234
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COMMISSIONER
-----------------------------------------------------
Name | MS. MARY T BASSETT
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 347-396-4100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | 395611
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------