1174520589 NPI number — MISS EILEEN KATHERINE KOSIERACKI D.O.

Table of content: MISS EILEEN KATHERINE KOSIERACKI D.O. (NPI 1174520589)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174520589 NPI number — MISS EILEEN KATHERINE KOSIERACKI D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOSIERACKI
Provider First Name:
EILEEN
Provider Middle Name:
KATHERINE
Provider Name Prefix Text:
MISS
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:
1174520589
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/09/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3916 LONG BRIDGE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBION
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14411-9310
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-589-6247
Provider Business Mailing Address Fax Number:
585-589-6351

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3916 LONG BRIDGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBION
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14411-9310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-589-6247
Provider Business Practice Location Address Fax Number:
585-589-6351
Provider Enumeration Date:
06/30/2005

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: 207Q00000X , with the licence number:  184108-1 , 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: 5900220 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 010184108 . This is a "BC/BS ROCHESTER BLUE CHOI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0103805 . This is a "INDEPENDENT HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00010093901 . This is a "UNIVERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5745356 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: MD134P . This is a "PREFERRED CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01248562 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000511199002 . This is a "COMMUNITY BLUE/ BC/BS BUF" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com