1093862369 NPI number — NORBERT J SZYMULA MD PC

Table of content: (NPI 1093862369)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093862369 NPI number — NORBERT J SZYMULA MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORBERT J SZYMULA MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1093862369
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
115 PROFESSIONAL PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOCKPORT
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14094-5369
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-433-1121
Provider Business Mailing Address Fax Number:
716-433-5425

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 PROFESSIONAL PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOCKPORT
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14094-5369
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-433-1121
Provider Business Practice Location Address Fax Number:
716-433-5425
Provider Enumeration Date:
01/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SZYMULA
Authorized Official First Name:
NORBERT
Authorized Official Middle Name:
JAMES
Authorized Official Title or Position:
PRESIDENT PHYSICIAN
Authorized Official Telephone Number:
716-433-1121

Provider Taxonomy Codes

  • Taxonomy code: 207YX0602X , with the licence number:  124226 , 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: 000508003001 . This is a "BLUE CROSSBLUE SHIELD WNY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00010176701 . This is a "UNIVERA PROVIDER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1005373 . This is a "INDEPENT HEALTH PROVIDER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00611445 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: COL 124226-2 . This is a "WORKER COMPENSATION" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com