1295799336 NPI number — MARGARET MARY MOLLY READER PT

Table of content: MARGARET MARY MOLLY READER PT (NPI 1295799336)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295799336 NPI number — MARGARET MARY MOLLY READER PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
READER
Provider First Name:
MARGARET
Provider Middle Name:
MARY MOLLY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CUDDY
Provider Other First Name:
CUDDY
Provider Other Middle Name:
MARY MOLLY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1295799336
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6301 TRANSIT RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEPEW
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14043-1051
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-684-0400
Provider Business Mailing Address Fax Number:
716-683-7028

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2700 NORTH FOREST RD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
GETZVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14068
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-639-3330
Provider Business Practice Location Address Fax Number:
716-639-3341
Provider Enumeration Date:
04/14/2006

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: 225100000X , with the licence number:  016355 , 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)

  • Identifier: 00011174501 . This is a "UNIVERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6697502 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P00057986 . This is a "RR MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000083697 . This is a "GHI HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 838670 . This is a "MANAGED PHYSICAL NETWORK" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000627362001 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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