1326120197 NPI number — LAUREEN ANN PERRY PA

Table of content: LAUREEN ANN PERRY PA (NPI 1326120197)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326120197 NPI number — LAUREEN ANN PERRY PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PERRY
Provider First Name:
LAUREEN
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PERRY
Provider Other First Name:
LAUREEN
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RPAC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1326120197
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/01/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
454 MAPLE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SARATOGA SPRINGS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12866-5532
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-587-1141
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
211 CHURCH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SARATOGA SPRINGS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12866
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-587-1141
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/20/2006

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: 363A00000X , with the licence number:  003090 , 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: 02554992 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".