1194782441 NPI number — CYNTHIA GRACE NEFF OD

Table of content: KAREN J HOLTSBERG YOUNG MS, CCC-SLP (NPI 1598918419)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194782441 NPI number — CYNTHIA GRACE NEFF OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEFF
Provider First Name:
CYNTHIA
Provider Middle Name:
GRACE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OD
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:
1194782441
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/14/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
332 FOURTH STREET
Provider Second Line Business Mailing Address:
PO BOX 367
Provider Business Mailing Address City Name:
FREEPORT
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16229-1130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-295-5127
Provider Business Mailing Address Fax Number:
724-295-5130

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
332 FOURTH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREEPORT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16229-1130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-295-5127
Provider Business Practice Location Address Fax Number:
724-295-5130
Provider Enumeration Date:
04/28/2006

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: 152W00000X , with the licence number:  OEG000594 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0017399 . This is a "DORAL VISION" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 254325 . This is a "HA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 01725030 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 314122 . This is a "UPMC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 569506 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: PA04888 . This is a "VBA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 397150 . This is a "NVA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 4478201 . This is a "DAVIS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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