1780868422 NPI number — KEENE NEUROPSYCHOLOGY CLINIC PLLC

Table of content: (NPI 1780868422)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780868422 NPI number — KEENE NEUROPSYCHOLOGY CLINIC PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KEENE NEUROPSYCHOLOGY CLINIC PLLC
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:
1780868422
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/03/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
103 ROXBURY ST
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
KEENE
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03431-8801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-357-8378
Provider Business Mailing Address Fax Number:
603-357-8375

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
103 ROXBURY ST
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
KEENE
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03431-8801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-357-8378
Provider Business Practice Location Address Fax Number:
603-357-8375
Provider Enumeration Date:
12/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
FRANKLIN
Authorized Official Middle Name:
C
Authorized Official Title or Position:
SOLE MEMBER, NEUROPSYCHOLOGIST
Authorized Official Telephone Number:
603-357-8378

Provider Taxonomy Codes

  • Taxonomy code: 103G00000X , with the licence number:  1034 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1015110 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com