1235648320 NPI number — SAMANTHA ANN SCHUPKE MSW STUDENT

Table of content: SAMANTHA ANN SCHUPKE MSW STUDENT (NPI 1235648320)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235648320 NPI number — SAMANTHA ANN SCHUPKE MSW STUDENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHUPKE
Provider First Name:
SAMANTHA
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW STUDENT
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:
1235648320
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/21/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4305 61ST ST APT D4
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODSIDE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11377-4949
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-974-7545
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16318 JAMAICA AVE STE 4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JAMAICA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11432-4901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-571-2441
Provider Business Practice Location Address Fax Number:
347-571-2448
Provider Enumeration Date:
09/21/2017

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: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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