1396843314 NPI number — MICHAEL LEDWITH BRENNAN FNP

Table of content: CAMILLE FABIAN OTD (NPI 1982481446)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396843314 NPI number — MICHAEL LEDWITH BRENNAN FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRENNAN
Provider First Name:
MICHAEL
Provider Middle Name:
LEDWITH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP
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:
1396843314
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
85 N CAVALIER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCOTTSVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14546
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:
500 HELENDALE RD
Provider Second Line Business Practice Location Address:
L20
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14609-3173
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-288-0890
Provider Business Practice Location Address Fax Number:
585-288-0893
Provider Enumeration Date:
09/21/2006

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: 363LF0000X , with the licence number:  330745 , 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: P019330475 . This is a "EXCELLUS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 109129BF . This is a "PREFERRED CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2026 www.npivalidator.com