1801989694 NPI number — WESTON PAXXON PT OT SLP PLLC

Table of content: (NPI 1801989694)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801989694 NPI number — WESTON PAXXON PT OT SLP PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WESTON PAXXON PT OT SLP 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:
1801989694
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/12/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2222 SULLIVAN TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EASTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18040-7958
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-467-3700
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1025 PLEASANTVILLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRIARCLIFF MANOR
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10510-1623
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-923-4400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/02/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LORENZ
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
631-467-3700

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  005053 , 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)