1043507726 NPI number — DR. VIVIAN SETSUKO SNYDER D.O.

Table of content: DR. VIVIAN SETSUKO SNYDER D.O. (NPI 1043507726)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043507726 NPI number — DR. VIVIAN SETSUKO SNYDER D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SNYDER
Provider First Name:
VIVIAN
Provider Middle Name:
SETSUKO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
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:
1043507726
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
572 SHERIDAN SQ
Provider Second Line Business Mailing Address:
#3
Provider Business Mailing Address City Name:
EVANSTON
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60202-4761
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-574-1909
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2650 RIDGE AVENUE
Provider Second Line Business Practice Location Address:
DEPARTMENT OF PATHOLOGY
Provider Business Practice Location Address City Name:
EVANSTON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-570-2730
Provider Business Practice Location Address Fax Number:
847-570-1938
Provider Enumeration Date:
07/01/2011

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: 207ZP0102X , with the licence number:  125060106 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com