1023123205 NPI number — MS. PATRICIA E HENTZE RPA-C

Table of content: MS. PATRICIA E HENTZE RPA-C (NPI 1023123205)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023123205 NPI number — MS. PATRICIA E HENTZE RPA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HENTZE
Provider First Name:
PATRICIA
Provider Middle Name:
E
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RPA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023123205
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2000
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUDSON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12534-2000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-828-8363
Provider Business Mailing Address Fax Number:
518-697-3388

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1301 RIVER ST
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
VALATIE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12184-9694
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-758-8300
Provider Business Practice Location Address Fax Number:
518-758-9679
Provider Enumeration Date:
08/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  006124 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 02246422 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000490562004 . This is a "BSNENY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 98329 . This is a "MVP HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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