1306894266 NPI number — ANNETTE MARIE BUCCI MSPT, CERT-MDT

Table of content: KATHRYN NEILL WOODS NP (NPI 1346967213)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306894266 NPI number — ANNETTE MARIE BUCCI MSPT, CERT-MDT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUCCI
Provider First Name:
ANNETTE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSPT, CERT-MDT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SMITH
Provider Other First Name:
ANNETTE
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSPT, CERT-MDT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1306894266
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/22/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
42 SARATOGA RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCOTIA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12302-3412
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-399-6861
Provider Business Mailing Address Fax Number:
518-399-6864

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1182 TROY SCHENECTADY RD
Provider Second Line Business Practice Location Address:
SUITE LL02
Provider Business Practice Location Address City Name:
LATHAM
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12110-1000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-220-9705
Provider Business Practice Location Address Fax Number:
518-220-9651
Provider Enumeration Date:
05/04/2006

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:  018842-1 , 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: 02252160 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2026 www.npivalidator.com