1053565887 NPI number — MRS. KIMBERLY A STRONG PT

Table of content: MRS. KIMBERLY A STRONG PT (NPI 1053565887)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053565887 NPI number — MRS. KIMBERLY A STRONG PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STRONG
Provider First Name:
KIMBERLY
Provider Middle Name:
A
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT
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:
1053565887
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/18/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8112 ROUTE 12
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
BARNEVELD
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13304-2122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-896-4330
Provider Business Mailing Address Fax Number:
315-896-4331

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
231 WALTON ST
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13202-1885
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-478-0380
Provider Business Practice Location Address Fax Number:
315-478-0388
Provider Enumeration Date:
11/06/2008

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: 225100000X , with the licence number:  030842 , 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: 00313539 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: AA0172 . This is a "MCR GRP FITNESS FORUM PT" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01815443 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: AA0171 . This is a "MCR GRP # FITNESS FORUM PT" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com