1457369654 NPI number — VIVIAN KATZENSTEIN FRIEDMAN PHD

Table of content: VIVIAN KATZENSTEIN FRIEDMAN PHD (NPI 1457369654)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457369654 NPI number — VIVIAN KATZENSTEIN FRIEDMAN PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRIEDMAN
Provider First Name:
VIVIAN
Provider Middle Name:
KATZENSTEIN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KATZENSTEIN
Provider Other First Name:
VIVIAN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1457369654
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/05/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 55310
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35255-5310
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-731-9701
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2205 CAHABA VALLEY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35242-2602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-968-1227
Provider Business Practice Location Address Fax Number:
334-218-5815
Provider Enumeration Date:
08/03/2006

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: 103TC0700X , with the licence number:  398 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 612812 . This is a "UBH-PLUS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 3300000005 . This is a "MEDICAID REHAB" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 6129811 . This is a "UBH-BASIC" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 000070786 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051501317 . This is a "BC FEDERAL EHBP" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: S02585 . This is a "VIVA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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