1912003096 NPI number — MRS. JANETTE HELEN BOTZENHART C.A.S.A.C.

Table of content: MRS. JANETTE HELEN BOTZENHART C.A.S.A.C. (NPI 1912003096)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912003096 NPI number — MRS. JANETTE HELEN BOTZENHART C.A.S.A.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOTZENHART
Provider First Name:
JANETTE
Provider Middle Name:
HELEN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
C.A.S.A.C.
Provider Gender Code:
F

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:
1912003096
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3020 BAILEY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BUFFALO
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14215-2814
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-831-1800
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
699 HERTEL AVE
Provider Second Line Business Practice Location Address:
SUITE 350
Provider Business Practice Location Address City Name:
BUFFALO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14207-2341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-831-1977
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/15/2006

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: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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