1144250119 NPI number — AMY SCHLIFTMAN

Table of content: AMY SCHLIFTMAN (NPI 1144250119)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144250119 NPI number — AMY SCHLIFTMAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHLIFTMAN
Provider First Name:
AMY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

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:
1144250119
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/15/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1228
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POINT REYES STATION
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94956-1228
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11431 CA HWY 1, SUITE 9
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POINT REYES STATION
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94956
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-663-9216
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/04/2006

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: 225X00000X , with the licence number:  OT6870 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: PT13083 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: OPT130831 . This is a "MEDICARE PPIN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: CT384000 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: PT0130830 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".