1295026375 NPI number — IRENE A BURNS

Table of content: (NPI 1295026375)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295026375 NPI number — IRENE A BURNS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IRENE A BURNS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SUMMIT PEDIATRICS
Provider Other Organization Name Type Code:
5
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:
1295026375
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
229 SUMMIT ST
Provider Second Line Business Mailing Address:
SUITE 4
Provider Business Mailing Address City Name:
BATAVIA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14020-1645
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-344-2504
Provider Business Mailing Address Fax Number:
585-815-4304

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
229 SUMMIT ST
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
BATAVIA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14020-1645
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-344-2504
Provider Business Practice Location Address Fax Number:
585-815-4304
Provider Enumeration Date:
04/25/2011

Additional Information

Authorized Official

Authorized Official Last Name:
BURNS
Authorized Official First Name:
IRENE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
SOLE PROPRIETOR
Authorized Official Telephone Number:
585-344-2504

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  149987 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208000000X , with the licence number: 256183 , 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: 00029358101 . This is a "UNIVERA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0094176 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0220 . This is a "BC/BS ROCHESTER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 03238084 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000508592001 . This is a "BC/BS WESTERN NEW YORK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00706547 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00010023201 . This is a "UNIVERA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000532478001 . This is a "BC/BS WESTERN NEW YORK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1216288 . This is a "INDEPENDENT HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: MDA130 . This is a "PREFERRED CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1206848 . This is a "INDEPENDENT HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: P010149987 . This is a "BLUE CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P010256183 . This is a "BLUE CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P020256183 . This is a "BC/BS ROCHESTER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 03238084 . This is a "PREFERRED CARE" identifier . This identifiers is of the category "OTHER".




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