1316091713 NPI number — DR. NORMA M SOUTHWORTH PHD

Table of content: DR. NORMA M SOUTHWORTH PHD (NPI 1316091713)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316091713 NPI number — DR. NORMA M SOUTHWORTH PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOUTHWORTH
Provider First Name:
NORMA
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SOUTHWORTH
Provider Other First Name:
NORMA
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1316091713
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:
57 WEST 75TH STREET
Provider Second Line Business Mailing Address:
APT 5C
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10023-2008
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-877-0039
Provider Business Mailing Address Fax Number:
212-239-0948

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19 WEST 34TH STREET
Provider Second Line Business Practice Location Address:
PENTHOUSE
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10001-3006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-877-0039
Provider Business Practice Location Address Fax Number:
212-239-0948
Provider Enumeration Date:
01/22/2007

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: 103TC0700X , with the licence number:  007859 , 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)