1255522066 NPI number — DR. LIDIA Z KLEPACZ MD

Table of content: DR. LIDIA Z KLEPACZ MD (NPI 1255522066)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255522066 NPI number — DR. LIDIA Z KLEPACZ MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KLEPACZ
Provider First Name:
LIDIA
Provider Middle Name:
Z
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1255522066
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/19/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
95 GRASSLANDS RD
Provider Second Line Business Mailing Address:
BHC NEW YORK MEDICAL COLLEGE
Provider Business Mailing Address City Name:
VALHALLA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10595-1652
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-493-7076
Provider Business Mailing Address Fax Number:
914-493-7739

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
95 GRASSLANDS RD
Provider Second Line Business Practice Location Address:
BHC NEW YORK MEDICAL COLLEGE
Provider Business Practice Location Address City Name:
VALHALLA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10595-1652
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-493-7076
Provider Business Practice Location Address Fax Number:
914-493-7739
Provider Enumeration Date:
08/06/2007

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: 2084P0800X , with the licence number:  244701 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084P0805X , with the licence number: 244701 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 02976947 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com