1194772491 NPI number — ERIK WILLIAM NIEMI D.O.

Table of content: ALOYSIUS RONALD CHENEY (NPI 1265105191)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194772491 NPI number — ERIK WILLIAM NIEMI D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NIEMI
Provider First Name:
ERIK
Provider Middle Name:
WILLIAM
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
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:
1194772491
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/30/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
322 DEWEY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BENNINGTON
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05201-2225
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-447-8700
Provider Business Mailing Address Fax Number:
802-447-8700

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
322 DEWEY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BENNINGTON
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05201-2225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-447-8700
Provider Business Practice Location Address Fax Number:
802-447-1500
Provider Enumeration Date:
05/30/2006

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: 207W00000X , with the licence number:  219513 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , with the licence number: 042-0007142 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 110035290A , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10078138 . This is a "CDPHP" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 59731 . This is a "VT BS" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: J26902 . This is a "MASS BS" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: J26902 . This is a "MASS BS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 364148 . This is a "MVP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 59731 . This is a "VTBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1010090 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000027329 . This is a "BMC" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 467617 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 467617 . This is a "TUFTS" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 000000027330 . This is a "BMC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 10078138 . This is a "CDPHP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 33621 . This is a "HNE" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 364148 . This is a "MVP" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".




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