1255508479 NPI number — MRS. LAURIE ANN SORGE LAURIE SORGE N.P.

Table of content: MRS. LAURIE ANN SORGE LAURIE SORGE N.P. (NPI 1255508479)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255508479 NPI number — MRS. LAURIE ANN SORGE LAURIE SORGE N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SORGE
Provider First Name:
LAURIE
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LAURIE SORGE N.P.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SORGE
Provider Other First Name:
LAURIE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LAURIE SORGE N.P.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1255508479
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14 PLEASANT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRPORT
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14450-1510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-425-1153
Provider Business Mailing Address Fax Number:
585-223-0018

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14 PLEASANT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRPORT
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14450-1510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-425-1153
Provider Business Practice Location Address Fax Number:
585-223-0018
Provider Enumeration Date:
05/15/2008

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: 363LG0600X , with the licence number:  340452 , 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)





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