1154420230 NPI number — ELAINE MARY SCHERBA-GERMAIN

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154420230 NPI number — ELAINE MARY SCHERBA-GERMAIN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHERBA-GERMAIN
Provider First Name:
ELAINE
Provider Middle Name:
MARY
Provider Name Prefix Text:
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:
1154420230
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/24/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4898 ROYAL CRAB AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SYRACUSE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13215-9310
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-430-7586
Provider Business Mailing Address Fax Number:
315-498-9129

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4898 ROYAL CRAB AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13215-9310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-430-7586
Provider Business Practice Location Address Fax Number:
315-498-9129
Provider Enumeration Date:
09/22/2006

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: 163WP0808X , with the licence number:  321851 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X , with the licence number: 301483 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: 400816 , 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: 02994838 . This is a "OCMS GRP MCD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1235184235 . This is a "OCMS GRP NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: BA1047 . This is a "OCMS GRP MCR" identifier . This identifiers is of the category "OTHER".