1386706869 NPI number — MS. AUDREY P BENNETT CSW

Table of content: MS. AUDREY P BENNETT CSW (NPI 1386706869)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386706869 NPI number — MS. AUDREY P BENNETT CSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BENNETT
Provider First Name:
AUDREY
Provider Middle Name:
P
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CSW
Provider Gender Code:
F

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:
1386706869
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:
10 STEUBEN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JERICHO
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11753-1441
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-433-4243
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 HEMPSTEAD AVE
Provider Second Line Business Practice Location Address:
SUITE 152
Provider Business Practice Location Address City Name:
ROCKVILLE CENTRE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11750
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-433-4243
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/14/2006

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: 1041C0700X , with the licence number:  R025833 , 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: 61017394957 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0035927 . This is a "PIN" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com