1164747879 NPI number — DARLENE ELIZABETH GARBIN

Table of content: DARLENE ELIZABETH GARBIN (NPI 1164747879)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164747879 NPI number — DARLENE ELIZABETH GARBIN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARBIN
Provider First Name:
DARLENE
Provider Middle Name:
ELIZABETH
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:
1164747879
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/06/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
RT 611 RR1 BOX 400
Provider Second Line Business Mailing Address:
TANNERSVILLE PLAZA
Provider Business Mailing Address City Name:
TANNERSVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18372
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-619-5413
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
RR 1 BOX 400
Provider Second Line Business Practice Location Address:
TANNERSVILLE PLAZA
Provider Business Practice Location Address City Name:
TANNERSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18372-9037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-619-5413
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/06/2010

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: 183500000X , with the licence number:  RP036121L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 183500000X , with the licence number: 039002-1 , 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)