1104889534 NPI number — SYPERT INSTITUTE PA

Table of content: (NPI 1104889534)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104889534 NPI number — SYPERT INSTITUTE PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SYPERT INSTITUTE PA
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:
1104889534
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
632 DEL PRADO BLVD N
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
CAPE CORAL
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33909-2253
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-772-5577
Provider Business Mailing Address Fax Number:
239-772-9961

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
632 DEL PRADO BLVD N
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
CAPE CORAL
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33909-2278
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-772-5577
Provider Business Practice Location Address Fax Number:
239-772-8879
Provider Enumeration Date:
04/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
O GRADY
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
239-432-0774

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2081P2900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3792099-00 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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