1093415135 NPI number — AMANDA JACQUELINE REICHARDT MS RDN CDN CPT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093415135 NPI number — AMANDA JACQUELINE REICHARDT MS RDN CDN CPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REICHARDT
Provider First Name:
AMANDA
Provider Middle Name:
JACQUELINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS RDN CDN CPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
REICHARDT
Provider Other First Name:
AMANDA
Provider Other Middle Name:
JACQUELINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS RDN CDN CPT
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1093415135
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
41 JOHN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BABYLON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11702-2932
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-204-3375
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
41 JOHN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BABYLON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11702-2932
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-205-3375
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/07/2023

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: 133V00000X , with the licence number:  86050604 , 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 © 2007-2025 www.npivalidator.com