1295700029 NPI number — KROP & NEIDIGH

Table of content: (NPI 1295700029)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295700029 NPI number — KROP & NEIDIGH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KROP & NEIDIGH
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:
COMMUNITY BEHAVIORAL SERVICES
Provider Other Organization Name Type Code:
3
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:
1295700029
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1543 KINGSLEY AVE
Provider Second Line Business Mailing Address:
SUITE 18 A
Provider Business Mailing Address City Name:
ORANGE PARK
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32073-4535
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-269-3324
Provider Business Mailing Address Fax Number:
904-264-2302

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1543 KINGSLEY AVE
Provider Second Line Business Practice Location Address:
SUITE 18 A
Provider Business Practice Location Address City Name:
ORANGE PARK
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32073-4535
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-269-3324
Provider Business Practice Location Address Fax Number:
904-264-2302
Provider Enumeration Date:
02/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NEIDIGH
Authorized Official First Name:
LARRY
Authorized Official Middle Name:
W
Authorized Official Title or Position:
CLINICAL PSYCHOLOGIST
Authorized Official Telephone Number:
904-269-3324

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PY4090 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com