1376564567 NPI number — DR. CRISTI A FREINBERG-TRUFAS DDS

Table of content: DR. CRISTI A FREINBERG-TRUFAS DDS (NPI 1376564567)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376564567 NPI number — DR. CRISTI A FREINBERG-TRUFAS DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FREINBERG-TRUFAS
Provider First Name:
CRISTI
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

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:
1376564567
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
658 COLUMBIA TPKE
Provider Second Line Business Mailing Address:
SUITE 3
Provider Business Mailing Address City Name:
EAST GREENBUSH
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12061-2111
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-477-2682
Provider Business Mailing Address Fax Number:
518-477-2691

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
658 COLUMBIA TPKE
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
EAST GREENBUSH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12061-2111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-477-2682
Provider Business Practice Location Address Fax Number:
518-477-2691
Provider Enumeration Date:
07/22/2006

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: 1223G0001X , with the licence number:  050030 , 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: 10068464-9312 . This is a "CDPHP ID#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02388214 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".