1356516652 NPI number — DR. H. TAD TROUTMAN PH.D.

Table of content: DR. H. TAD TROUTMAN PH.D. (NPI 1356516652)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356516652 NPI number — DR. H. TAD TROUTMAN PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TROUTMAN
Provider First Name:
H.
Provider Middle Name:
TAD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1356516652
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
31 OAK ST
Provider Second Line Business Mailing Address:
SUITE 21
Provider Business Mailing Address City Name:
PATCHOGUE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11772-2841
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-598-9217
Provider Business Mailing Address Fax Number:
866-586-3157

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
31 OAK ST
Provider Second Line Business Practice Location Address:
SUITE 21
Provider Business Practice Location Address City Name:
PATCHOGUE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11772-2841
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-598-9217
Provider Business Practice Location Address Fax Number:
866-586-3157
Provider Enumeration Date:
04/28/2008

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: 103TC0700X , with the licence number:  017613 , 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: 02981244 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 60054 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1089280 . This is a "AFFINITY HEALTH PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com