1033556345 NPI number — MISS ERIN MCMAHON

Table of content: MISS ERIN MCMAHON (NPI 1033556345)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033556345 NPI number — MISS ERIN MCMAHON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCMAHON
Provider First Name:
ERIN
Provider Middle Name:
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
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:
1033556345
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23 W GLANN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
APALACHIN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13732-4026
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:
607-625-4251

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23 W GLANN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
APALACHIN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13732-4026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-222-8977
Provider Business Practice Location Address Fax Number:
607-625-4251
Provider Enumeration Date:
05/28/2013

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: 171M00000X , 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: REG2081611-578416C3 . This is a "NY STATE DEPT OF HEALTH BUREAU OF EARLY INTERVENTION" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".