1760880736 NPI number — BECKY J BUDZINA BSC

Table of content: BECKY J BUDZINA BSC (NPI 1760880736)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760880736 NPI number — BECKY J BUDZINA BSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUDZINA
Provider First Name:
BECKY
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BSC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WALK
Provider Other First Name:
BECKY
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
BSC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1760880736
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/23/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
320 HIGHLAND DR
Provider Second Line Business Mailing Address:
PO BOX 597
Provider Business Mailing Address City Name:
MOUNTVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17554-1232
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-285-7121
Provider Business Mailing Address Fax Number:
717-285-5302

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2330 VARTAN WAY
Provider Second Line Business Practice Location Address:
STE. 204
Provider Business Practice Location Address City Name:
HARRISBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17110-9763
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-920-9434
Provider Business Practice Location Address Fax Number:
717-920-9197
Provider Enumeration Date:
12/08/2014

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: 103K00000X , with the licence number:  BH002113 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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