DR. ADVAITH BONGU MD, NPI 1356577035 — NEW YORK (NY)

NPI 1356577035

10+ Years Experience Individual

DR. ADVAITH BONGU MD

06.08.2009
PROVIDER ENUMERATION DATE
04/26/2018
LAST UPDATE DATE
1356577035
NPI NUMBER

About DR. ADVAITH BONGU

Sole proprietor? No, Entity Type 1 Provider (Individual) is not a Sole Proprietor.

DR. ADVAITH BONGU is a provider established in NEW YORK, NY. The NPI number of DR. ADVAITH BONGU is 1356577035 and was assigned on 06.08.2009. The practitioners primary taxonomy code is: 204F00000X with license number: 283949 NY .

Mailing address

  • City: NEW YORK
  • State: NY
  • Postal code: 100323720
  • Phone: 2123050914
  • Fax: 2123054343
  • Address: 622 W 168TH ST

Primary Practice Address

  • Region : NEW YORK, NY
  • NPI : 1356577035
  • Phone : 2123050914
  • Fax : 2123054343
  • Postalcode : 100323720
  • Address : 622 W 168TH ST

Provider taxonomy - Transplant Surgery

  • Taxonomy code: 204F00000X
  • License number: 283949
  • License state: NY

The taxonomy is the primary taxonomy (there can be only one per NPI record).

Contacts:

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  • DR. ADVAITH BONGU MD
  • Address : 622 W 168TH ST
  • Region : NEW YORK, NY
  • NPI : 1356577035
  • Phone : 2123050914
  • Fax : 2123054343
  • Postalcode : 100323720

Reference NPI Information. Full replica of the CMS (NPPES) NPI record

Field Name Value
Provider First Line Business Practice Location Address622 W 168TH ST
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 NameNEW YORK
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameNY
The State or Province name in the location address of the provider being identified.
Provider Business Practice Location Address Postal Code100323720
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Telephone Number2123050914
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number2123054343
The fax number associated with the location address of the provider being identified.
NPI1356577035
10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
Healthcare Provider Taxonomy 1204F00000X
Provider Enumeration Date06.08.2009
The date the provider was assigned a unique identifier (assigned an NPI).
Last Updated04/26/2018
The date that a record was last updated or changed.
Entity TypeIndividual
Code describing the type of health care provider that is being assigned an NPI. Codes are:
  • 1 = (Person): individual human being who furnishes health care;
  • 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Provider Organization Name (Legal Business Name)DR. ADVAITH BONGU
Provide organization name (legal business name used to file tax returns with the IRS). The Organization Name field allows the following special characters: ampersand, apostrophe, "at" sign, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.
Provider First Line Business Mailing Address622 W 168TH ST
The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
Provider Business Mailing Address City NameNEW YORK
The City name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address City name".
Provider Business Mailing Address State NameNY
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
Provider Business Mailing Address Postal Code100323720
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
Provider Business Mailing Address Telephone Number2123050914
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
Provider Business Mailing Address Fax Number2123054343
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
Healthcare Provider Taxonomy Code #1204F00000X
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
Healthcare Provider Taxonomy 1Transplant Surgery
Provider License Number 1283949
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.
Provider License Number State Code 1NY
Healthcare Provider Primary Taxonomy Switch 1Y
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
Provider Gender CodeM
  • M - male
  • F - female
Is sole proprietorN
  • X - Not Answered
  • Y - Yes, Entity Type 1 Provider (Individual) is a Sole Proprietor
  • N - No, Entity Type 1 Provider (Individual) is not a Sole Proprietor
X

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