1356511265 NPI number — MRS. ABIGAIL J TRNOVSKY LISCW

Table of content: MRS. ABIGAIL J TRNOVSKY LISCW (NPI 1356511265)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356511265 NPI number — MRS. ABIGAIL J TRNOVSKY LISCW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRNOVSKY
Provider First Name:
ABIGAIL
Provider Middle Name:
J
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LISCW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GINGRICH
Provider Other First Name:
ABIGAIL
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1356511265
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/21/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
835 CENTRAL AVE STE 126
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOVER
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03820-2506
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-652-1091
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 OLD ROLLINSFORD RD STE 302
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOVER
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03820-2819
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-742-9200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/06/2008

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: 1041C0700X , with the licence number:  1641 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3089550 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".