1780690990 NPI number — LAWRENCE R BIRZON DC, PT

Table of content: LAWRENCE R BIRZON DC, PT (NPI 1780690990)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780690990 NPI number — LAWRENCE R BIRZON DC, PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BIRZON
Provider First Name:
LAWRENCE
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DC, PT
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:
1780690990
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3734 DELAWARE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENMORE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14217-1002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-874-1500
Provider Business Mailing Address Fax Number:
716-874-6396

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3734 DELAWARE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENMORE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14217-1002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-874-1500
Provider Business Practice Location Address Fax Number:
716-874-6396
Provider Enumeration Date:
07/31/2006

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: 225100000X , with the licence number:  009221-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , with the licence number: X003059-1 , 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)

  • Identifier: 00020137801 . This is a "UNIVERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1030314 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 8803885 . This is a "INDEPENDENT HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000608461004 . This is a "BC BS COMMUNITY BLUE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00978432 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 801640 . This is a "EMPIRE PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00011191301 . This is a "UNIVERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00208461002 . This is a "BC BS COMMUNITY BLUE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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