1114003134 NPI number — ANNE M. VIRGILIO L.C.S.W.

Table of content: KELLY NIERGARTH (NPI 1811219272)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114003134 NPI number — ANNE M. VIRGILIO L.C.S.W.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VIRGILIO
Provider First Name:
ANNE
Provider Middle Name:
M.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
L.C.S.W.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCGREAL
Provider Other First Name:
ANNE
Provider Other Middle Name:
M.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
L.C.S.W.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1114003134
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17 WOODHOLLOW RD.
Provider Second Line Business Mailing Address:
P.O. BOX 584
Provider Business Mailing Address City Name:
GREAT RIVER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11739-0584
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-581-3194
Provider Business Mailing Address Fax Number:
631-286-5720

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 STATION CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLPORT
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11713-2453
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-286-5710
Provider Business Practice Location Address Fax Number:
631-286-5720
Provider Enumeration Date:
10/31/2006

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: 1041C0700X , with the licence number:  R049326-1 , 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: 049326 . This is a "HIP HEALTH PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 127125 . This is a "VYTRA PROVIDER NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2065197 . This is a "CIGNA PROVIDER NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6259678 . This is a "UNITED BEHAVIORAL HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7481809 . This is a "GHI PROVIDER NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 158830 . This is a "VALUEOPTIONS PROVIDER NUM" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P2550205 . This is a "OXFORD HEALTH PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02237034 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7648536 . This is a "AETNA PROVIDER NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com