1659314045 NPI number — DR. HOWARD S GROTSKY ED.D.

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 1659314045 NPI number — DR. HOWARD S GROTSKY ED.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GROTSKY
Provider First Name:
HOWARD
Provider Middle Name:
S
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
ED.D.
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:
1659314045
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/24/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5010 RANDALL PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28403-2829
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-791-5719
Provider Business Mailing Address Fax Number:
910-799-8180

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5010 RANDALL PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28403-2829
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-791-5719
Provider Business Practice Location Address Fax Number:
910-799-8180
Provider Enumeration Date:
06/13/2006

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:  412 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 51751 . This is a "CIGNA BEHAVIORAL HEALTH #" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 6000123 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 192530000 . This is a "MAGELLEN PROVIDER NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: A314799 . This is a "VALUE OPTIONS GROUP #" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 12748 . This is a "PARNTERS NATIONAL HEALTH" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 03655 . This is a "BLUE CROSS BLUE SHIELD #" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 51751 . This is a "CIGNA PROVIDER NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 066683 . This is a "VALUE OPTIONS PROVIDER #" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 4279018 . This is a "AETNA PROVIDER NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: B5436 . This is a "MEDCOST PROVIDER NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".