1215916507 NPI number — PAUL NEUTHALER LCSW R

Table of content: PAUL NEUTHALER LCSW R (NPI 1215916507)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215916507 NPI number — PAUL NEUTHALER LCSW R

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEUTHALER
Provider First Name:
PAUL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW R
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:
1215916507
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:
333 ADAMS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEDFORD HILLS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10507-2001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-242-0725
Provider Business Mailing Address Fax Number:
914-242-5152

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
333 ADAMS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEDFORD HILLS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10507-2001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-242-0725
Provider Business Practice Location Address Fax Number:
914-242-5152
Provider Enumeration Date:
01/13/2006

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: 104100000X , with the licence number:  0533721 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: NU9941 , issued by the state of ( NY ) . This identifiers is of the category "MEDICARE ID-TYPE UNSPECIFIED".