1427128628 NPI number — BARDONIA CHIROPRACTIC OFFICE, PLLC

Table of content: (NPI 1427128628)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427128628 NPI number — BARDONIA CHIROPRACTIC OFFICE, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BARDONIA CHIROPRACTIC OFFICE, 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:
1427128628
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
28 BARDONIA RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BARDONIA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10954-2123
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-623-1558
Provider Business Mailing Address Fax Number:
845-623-6437

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
28 BARDONIA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARDONIA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10954-2123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-623-1558
Provider Business Practice Location Address Fax Number:
845-623-6437
Provider Enumeration Date:
11/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LENTINI
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
845-623-1558

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  X007536 , 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: 5803795 . This is a "GHI ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4575780 . This is a "AETNA ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 113423471 . This is a "ICM ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: X007536 . This is a "NY LICENSE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7145443002 . This is a "CIGNA ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: P3890540 . This is a "OXFORD ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: XCWJH . This is a "EMPIRE BLUE CROSS SHIELD" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com