1235152604 NPI number — BIOFEEDBACK ASSOCIATES OF NE FL

Table of content: (NPI 1235152604)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235152604 NPI number — BIOFEEDBACK ASSOCIATES OF NE FL

Organization/Personal Information

Employer Identification Number (EIN):
N/A
Provider Organization Name:
BIOFEEDBACK ASSOCIATES OF NE FL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1235152604
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/28/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11512 LAKE MEAD AVE
Provider Second Line Business Mailing Address:
SUITE 703
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32256
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-646-0054
Provider Business Mailing Address Fax Number:
904-646-0930

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11512 LAKE MEAD AVE
Provider Second Line Business Practice Location Address:
SUITE 703
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32256
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-646-0054
Provider Business Practice Location Address Fax Number:
904-646-0930
Provider Enumeration Date:
07/25/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
THARP-WRIGHT
Authorized Official First Name:
ANNETTE
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
OWNER/ COUNSELOR
Authorized Official Telephone Number:
904-646-0054

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  MH6843 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: SW1447 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: SW2527 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: MH4616 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: MH5132 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: MH5155 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: MH2969 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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