1013120179 NPI number — SYNTACTICS LLC

Table of content: (NPI 1013120179)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013120179 NPI number — SYNTACTICS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SYNTACTICS LLC
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:
6
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:
1013120179
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/26/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
932 HUNGERFORD DRIVE
Provider Second Line Business Mailing Address:
SUITE 29A
Provider Business Mailing Address City Name:
ROCKVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20850-1752
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-424-7701
Provider Business Mailing Address Fax Number:
301-424-7703

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
44081 PIPELINE PLZ STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASHBURN
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-424-7701
Provider Business Practice Location Address Fax Number:
301-424-7703
Provider Enumeration Date:
05/07/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PARK
Authorized Official First Name:
GRACE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER, CLINICAL DIRECTOR, SLP
Authorized Official Telephone Number:
703-729-6291

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  2202004766 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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