1114090164 NPI number — DR. DONNA JO BACH-HEITNER D.C.

Table of content: DR. DONNA JO BACH-HEITNER D.C. (NPI 1114090164)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114090164 NPI number — DR. DONNA JO BACH-HEITNER D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BACH-HEITNER
Provider First Name:
DONNA
Provider Middle Name:
JO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BACH
Provider Other First Name:
DONNA
Provider Other Middle Name:
J.
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.C.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1114090164
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
202 VINCENT DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST MEADOW
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11554-2425
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-794-3600
Provider Business Mailing Address Fax Number:
516-794-3609

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
202 VINCENT DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST MEADOW
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11554-2425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-794-3600
Provider Business Practice Location Address Fax Number:
516-794-3609
Provider Enumeration Date:
11/16/2006

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: 111N00000X , with the licence number:  X3455 , 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: C03455-5 . This is a "WORKERS COMPENSATION" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P643908 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 51568 . This is a "VYTRA" identifier . This identifiers is of the category "OTHER".
  • Identifier: X23771 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".