1174656284 NPI number — MRS. JOLENE MARIE O'BRIEN PT

Table of content: MRS. JOLENE MARIE O'BRIEN PT (NPI 1174656284)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174656284 NPI number — MRS. JOLENE MARIE O'BRIEN PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
O'BRIEN
Provider First Name:
JOLENE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MORGAN
Provider Other First Name:
JOLENE
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1174656284
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/16/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2230 COUNTY ROUTE 126
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENWOOD
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14839-9738
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
607-225-4226
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
134 SENECA ST
Provider Second Line Business Practice Location Address:
GST BOCES
Provider Business Practice Location Address City Name:
HORNELL
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14843-1324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-324-1525
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/14/2007

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: 225100000X , with the licence number:  022583-1 , 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)