1992856397 NPI number — JAY T HASSENFRATZ DPM

Table of content: JAY T HASSENFRATZ DPM (NPI 1992856397)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992856397 NPI number — JAY T HASSENFRATZ DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HASSENFRATZ
Provider First Name:
JAY
Provider Middle Name:
T
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

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:
1992856397
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1026 UNION RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST SENECA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14224-3445
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-712-0851
Provider Business Mailing Address Fax Number:
716-712-0853

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1026 UNION RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST SENECA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14224-3445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-712-0851
Provider Business Practice Location Address Fax Number:
716-712-0853
Provider Enumeration Date:
01/15/2007

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: 213E00000X , with the licence number:  N005872-1 , 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)

  • Identifier: 000526791007 . This is a "HEALTHNOW" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7430364 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000526791010 . This is a "BC/BS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 480015008 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00026000303 . This is a "UNIVERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000526791009 . This is a "HEALTHNOW DME" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000526791006 . This is a "HEALTHNOW" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000526791011 . This is a "BC/BS DME" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 160918194 . This is a "TRICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P05872-8W . This is a "WORKERS COMPENSATION" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000526791008 . This is a "HEALTHNOW" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02324532 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 142517EQ . This is a "PREF CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00026000302 . This is a "UNIVERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0086185 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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