1639318637 NPI number — GERALD A NIEDZWIECKI MD PA

Table of content: (NPI 1639318637)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639318637 NPI number — GERALD A NIEDZWIECKI MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GERALD A NIEDZWIECKI MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1639318637
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/29/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2730 N MCMULLEN BOOTH RD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
CLEARWATER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33761-3302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-791-7300
Provider Business Mailing Address Fax Number:
727-723-9010

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2730 N MCMULLEN BOOTH RD
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
CLEARWATER
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33761-3302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-286-8929
Provider Business Practice Location Address Fax Number:
727-286-8933
Provider Enumeration Date:
02/13/2009

Additional Information

Authorized Official

Authorized Official Last Name:
NIEDZWIECKI
Authorized Official First Name:
GERALD
Authorized Official Middle Name:
ANTHONY
Authorized Official Title or Position:
PRESIDENT/SHAREHOLDER
Authorized Official Telephone Number:
727-791-7300

Provider Taxonomy Codes

  • Taxonomy code: 2085N0700X , with the licence number:  ME81474 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: ME0070649 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: ME81474 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0204X , with the licence number: ME0070649 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085U0001X , with the licence number: ME0070649 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: PAT9104325 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 203364 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 300123717 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 31439 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 4593565 . This is a "AETNA PPO" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1600774 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 220039 . This is a "AMERIGROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 250195300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2648373 . This is a "AETNA HMO" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 009735700 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com