1790880516 NPI number — DERRY NEUROLOGICAL ASSOCIATES, PC

Table of content: (NPI 1790880516)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790880516 NPI number — DERRY NEUROLOGICAL ASSOCIATES, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DERRY NEUROLOGICAL ASSOCIATES, PC
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:
1790880516
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
44 BIRCH ST STE 305
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DERRY
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03038-2752
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-434-3525
Provider Business Mailing Address Fax Number:
603-434-2877

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
44 BIRCH ST STE 305
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DERRY
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03038-2752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-434-3525
Provider Business Practice Location Address Fax Number:
603-434-2877
Provider Enumeration Date:
09/14/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RIND
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
603-434-3525

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084N0400X , with the licence number: 8276 JEFFREY RIND , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: 11639 JOHN RESCIGNO , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 30212511 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".