1184727380 NPI number — DANIEL J SCHWENK PT

Table of content: DANIEL J SCHWENK PT (NPI 1184727380)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184727380 NPI number — DANIEL J SCHWENK PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHWENK
Provider First Name:
DANIEL
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
M

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:
1184727380
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:
800 CARTER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14621
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-339-4793
Provider Business Mailing Address Fax Number:
585-336-4845

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 EMPIRE DR
Provider Second Line Business Practice Location Address:
EMPIRE DRIVE HEALTH CENTER
Provider Business Practice Location Address City Name:
WEST SENECA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-668-6352
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/06/2006

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: 225100000X , with the licence number:  012322 , 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: 00011283007 . This is a "UNIVERA LEGACY#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 9304085 . This is a "IHA LEGACY#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0145386 . This is a "GHI PPO LEGACY#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 050331000070 . This is a "FIDELIS LEGACY#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 08494418 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 159882FT . This is a "PREFERRED CARE LEGACY#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000623094004 . This is a "HEALTH NOW BCBS LEGACY#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P00249362 . This is a "MEDICARE RAILROAD LEGACY#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".