1396458642 NPI number — CARDINAL FAMILY MEDICINE, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396458642 NPI number — CARDINAL FAMILY MEDICINE, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARDINAL FAMILY MEDICINE, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1396458642
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
97 ENTERPRISE DR # 11144
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWBURGH
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12550-8335
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 WALNUT ST STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTGOMERY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12549-2261
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-287-0037
Provider Business Practice Location Address Fax Number:
845-764-9510
Provider Enumeration Date:
01/03/2023

Additional Information

Authorized Official

Authorized Official Last Name:
HOWARD
Authorized Official First Name:
ALEXANDRIA
Authorized Official Middle Name:
DANIELLE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
216-526-9619

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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