1437154655 NPI number — MR. MATTHEW BERNARD GERMOND DC

Table of content: DR. RAVI J PATEL MD (NPI 1275572828)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437154655 NPI number — MR. MATTHEW BERNARD GERMOND DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GERMOND
Provider First Name:
MATTHEW
Provider Middle Name:
BERNARD
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
DC
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:
1437154655
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/20/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
109 NORTH MAIN STREET
Provider Second Line Business Mailing Address:
SUITE 2
Provider Business Mailing Address City Name:
BAINBRIDGE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13733
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
607-967-2000
Provider Business Mailing Address Fax Number:
607-967-2004

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
109 NORTH MAIN STREET
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
BAINBRIDGE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13733
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-967-2000
Provider Business Practice Location Address Fax Number:
607-967-2004
Provider Enumeration Date:
06/15/2005

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: 111N00000X , with the licence number:  X009101-1 , 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: NY09101 . This is a "MVP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5898461 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7194094 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: C09101-9 . This is a "WORKERS COMP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10064161 . This is a "CDPHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3878490001 . This is a "NSC INDEN #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 98L1051 . This is a "LANDMARK AC" identifier . This identifiers is of the category "OTHER".
  • Identifier: X4C66 . This is a "EMPIRE BC/BS" identifier . This identifiers is of the category "OTHER".




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