1083873392 NPI number — SUSAN NEEL GILLEENY BEHRENS D.P.T.

Table of content: DR. JOHN FREDERICK GOLAN MD (NPI 1952452393)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083873392 NPI number — SUSAN NEEL GILLEENY BEHRENS D.P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEHRENS
Provider First Name:
SUSAN
Provider Middle Name:
NEEL GILLEENY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GILLEENY
Provider Other First Name:
SUSAN
Provider Other Middle Name:
NEEL
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.T.A.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1083873392
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26 FOREST LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WADING RIVER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11792-1117
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-929-6189
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
607 MIDDLE COUNTRY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORAM
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11727-3345
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-732-3900
Provider Business Practice Location Address Fax Number:
631-732-3908
Provider Enumeration Date:
06/03/2008

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:  030242 , 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)





Copyright © 2007-2024 www.npivalidator.com