1295177046 NPI number — TAMMY LAURA WOOD

Table of content: TAMMY LAURA WOOD (NPI 1295177046)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295177046 NPI number — TAMMY LAURA WOOD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOOD
Provider First Name:
TAMMY
Provider Middle Name:
LAURA
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:
LANGDON
Provider Other First Name:
TAMMY
Provider Other Middle Name:
LAURA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
BC-HIS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1295177046
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1900 W GENESEE ST
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:
13204-1814
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-468-1926
Provider Business Mailing Address Fax Number:
315-468-2169

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1900 W GENESEE ST
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:
13204-1814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-468-1926
Provider Business Practice Location Address Fax Number:
315-468-2169
Provider Enumeration Date:
07/22/2013

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: 237700000X , with the licence number:  14000016596 , 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: 14000016596 . This is a "NEW YORK STATE LICENSE NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".