1164600748 NPI number — MISS JESSE SUZANNE KUZMAN IMF

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164600748 NPI number — MISS JESSE SUZANNE KUZMAN IMF

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

KUZMAN

Provider First Name:

JESSE

Provider Middle Name:

SUZANNE

Provider Name Prefix Text:

MISS

Provider Name Suffix Text:

Provider Credential Text:

IMF

Provider Gender Code:

F

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:

1164600748

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

07/28/2014

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

35 CONGRESS ST

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

SALEM

Provider Business Mailing Address State Name:

MA

Provider Business Mailing Address Postal Code:

01970-5529

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

978-542-1951

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

35 CONGRESS ST

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

SALEM

Provider Business Practice Location Address State Name:

MA

Provider Business Practice Location Address Postal Code:

01970-5529

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

978-542-1951

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

02/05/2008

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 07533 . This is a "ADOL TX ANTIOCH" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: 07551 . This is a "ADULT TX BRENTWOOD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: 07557 . This is a "DMC ADOL BRENTWOOD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: 07536 . This is a "DMC ADOL ANTIOCH" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: 07555 . This is a "DRUG COURT" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: 07531 . This is a "ADULT TX ANTIOCH" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: 07552 . This is a "DMC ADULT BRENTWOOD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: 07534 . This is a "DMC ADULT ANTIOCH" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: 07553 . This is a "ADOL TX BRENTWOOD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: 070753 . This is a "MASTER PROVIDER NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: 0726 . This is a "DRUG M/CAL BILLING NUM" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: 0753 . This is a "DRUG M/CAL BILLING NUM" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".