1538195433 NPI number — DEBRA ANN MENESS M.D., D.O.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538195433 NPI number — DEBRA ANN MENESS M.D., D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MENESS
Provider First Name:
DEBRA
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D., D.O.
Provider Gender Code:
F

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:
1538195433
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/25/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
SAINT REGIS MOHAWK TRIBE HEALTH SERVICES
Provider Second Line Business Mailing Address:
404 STATE ROUTE 37
Provider Business Mailing Address City Name:
HOGANSBURG
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13655
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-358-3141
Provider Business Mailing Address Fax Number:
518-358-9175

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
SAINT REGIS MOHAWK TRIBE HEALTH SERVICES
Provider Second Line Business Practice Location Address:
404 STATE ROUTE 37
Provider Business Practice Location Address City Name:
HOGANSBURG
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13655
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-358-3141
Provider Business Practice Location Address Fax Number:
518-358-9175
Provider Enumeration Date:
06/23/2006

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: 207P00000X , with the licence number:  257775 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 257775 , 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: 03265556 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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