1023281540 NPI number — PENN TRAFFIC COMPANY, THE

Table of content: (NPI 1023281540)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023281540 NPI number — PENN TRAFFIC COMPANY, THE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PENN TRAFFIC COMPANY, THE
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:
1023281540
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 STATE FAIR BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SYRACUSE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13209-1070
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-461-2600
Provider Business Mailing Address Fax Number:
315-461-2304

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 STATE FAIR BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13209-1070
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-461-2600
Provider Business Practice Location Address Fax Number:
315-461-2304
Provider Enumeration Date:
04/04/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MAHONEY
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
VICE PRESIDENT/CORPROATE COUNCIL
Authorized Official Telephone Number:
315-461-2347

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 449 . This is a "NCPDP CHAIN CODE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 454 . This is a "NCPDP CHAIN CODE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 452 . This is a "NCPCP CHAIN CODE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 993 . This is a "NCPDP FRANCHISE CODE" identifier . This identifiers is of the category "OTHER".