1144217134 NPI number — MARY ROBIN MACINTYRE CNM, RN, NP

Table of content: MARY ROBIN MACINTYRE CNM, RN, NP (NPI 1144217134)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144217134 NPI number — MARY ROBIN MACINTYRE CNM, RN, NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MACINTYRE
Provider First Name:
MARY
Provider Middle Name:
ROBIN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CNM, RN, NP
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:
1144217134
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/19/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 KINGS HWY S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14617-5504
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-922-0553
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1415 PORTLAND AVE
Provider Second Line Business Practice Location Address:
STE 400
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14621-3038
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-922-4200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/04/2005

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: 176B00000X , with the licence number:  000617-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LX0001X , with the licence number: 360470-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367A00000X , with the licence number: 000617 , 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: 000924350001 . This is a "HEALTHNOW PROVIDER ID#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 161568690 . This is a "EMPIRE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7277063 . This is a "AETNA PROVIDER ID NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01874840 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: P010000617 . This is a "BLUE CHOICE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 161568690 . This is a "POMCO PROVIDER ID#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1899724 . This is a "GHI PPO PROVIDER ID#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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