1801816327 NPI number — BURDETT ORTHOPEDICS, PC

Table of content: (NPI 1801816327)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801816327 NPI number — BURDETT ORTHOPEDICS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BURDETT ORTHOPEDICS, 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:
1801816327
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/07/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2200 BURDETT AVE
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
TROY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12180-2451
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-272-0122
Provider Business Mailing Address Fax Number:
518-272-1260

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2200 BURDETT AVE
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
TROY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12180-2451
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-272-0122
Provider Business Practice Location Address Fax Number:
518-272-1260
Provider Enumeration Date:
07/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ISENBERGH
Authorized Official First Name:
MARY
Authorized Official Middle Name:
C
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
518-272-0122

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CF7281 . This is a "RR MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0616930001 . This is a "DMERC" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01956050 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1490 . This is a "CDPHP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 200053732 . This is a "MVPHP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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