1760548283 NPI number — SUSAN BARBARA MIZGALA

Table of content: SUSAN BARBARA MIZGALA (NPI 1760548283)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760548283 NPI number — SUSAN BARBARA MIZGALA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MIZGALA
Provider First Name:
SUSAN
Provider Middle Name:
BARBARA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1760548283
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/05/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11050 MOUNT BELVEDERE BLVD
Provider Second Line Business Mailing Address:
USA MEDDAC ATTN: CREDENTIALS
Provider Business Mailing Address City Name:
FORT DRUM
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13602-5438
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-772-4025
Provider Business Mailing Address Fax Number:
315-772-9498

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
USAHC-STUTTGART
Provider Second Line Business Practice Location Address:
UNIT 30401
Provider Business Practice Location Address City Name:
STUTTGART
Provider Business Practice Location Address State Name:
GERMANY
Provider Business Practice Location Address Postal Code:
APO
Provider Business Practice Location Address Country Code:
DE
Provider Business Practice Location Address Telephone Number:
07116807122
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/29/2006

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: 163W00000X , with the licence number:  537378-1 , 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)





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