1255408902 NPI number — DR. BARBARA MERYL SHAW-ZIRT PH.D.

Table of content: DR. BARBARA MERYL SHAW-ZIRT PH.D. (NPI 1255408902)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255408902 NPI number — DR. BARBARA MERYL SHAW-ZIRT PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHAW-ZIRT
Provider First Name:
BARBARA
Provider Middle Name:
MERYL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
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:
1255408902
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/02/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 SAINT JOHN ST
Provider Second Line Business Mailing Address:
PO BOX 1311
Provider Business Mailing Address City Name:
MONTICELLO
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12701-2137
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-794-1868
Provider Business Mailing Address Fax Number:
845-794-5961

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 SAINT JOHN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTICELLO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12701-2137
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-794-1868
Provider Business Practice Location Address Fax Number:
845-794-5961
Provider Enumeration Date:
11/29/2006

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: 103TC0700X , with the licence number:  014688 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC2200X , with the licence number: 014688 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 211452 . This is a "UNITED BEHAVIORAL HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 503089 . This is a "VALUE OPTIONS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02145182 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 603442 . This is a "MVP HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1035160 . This is a "HUDSON HEALTH PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: IP559283 . This is a "MAGELLAN BEHAVIORAL HEALT" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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