1255830634 NPI number — MR. CORY CAMPOPIANO ATC

Table of content: MR. CORY CAMPOPIANO ATC (NPI 1255830634)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255830634 NPI number — MR. CORY CAMPOPIANO ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAMPOPIANO
Provider First Name:
CORY
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
ATC
Provider Gender Code:
M

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:
1255830634
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/11/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
39/12-16 SOI NICHADA THANI, SAMAKEE ROAD
Provider Second Line Business Mailing Address:
SAMAKEE GARDENS APT #5B
Provider Business Mailing Address City Name:
PAKKRET
Provider Business Mailing Address State Name:
NONTHABURI
Provider Business Mailing Address Postal Code:
11120
Provider Business Mailing Address Country Code:
TH
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
39/12-16 SOI NICHADA THANI, SAMAKEE ROAD
Provider Second Line Business Practice Location Address:
SAMAKEE GARDENS APT #5B
Provider Business Practice Location Address City Name:
PAKKRET
Provider Business Practice Location Address State Name:
NONTHABURI
Provider Business Practice Location Address Postal Code:
11120
Provider Business Practice Location Address Country Code:
TH
Provider Business Practice Location Address Telephone Number:
678-702-3976
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/12/2018

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: 2255A2300X , with the licence number:  2000019910 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2000019910 . This is a "BOARD OF CERTIFICATION" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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