1437104163 NPI number — AMBUR GREBNER DPT

Table of content: AMBUR GREBNER DPT (NPI 1437104163)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437104163 NPI number — AMBUR GREBNER DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GREBNER
Provider First Name:
AMBUR
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHENELLY
Provider Other First Name:
AMBUR
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1437104163
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:
800 CARTER STREET
Provider Second Line Business Mailing Address:
ATTN KELLY STEELE
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14621
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-339-4793
Provider Business Mailing Address Fax Number:
585-336-4845

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 CARTER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14621-2604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-338-1400
Provider Business Practice Location Address Fax Number:
585-336-4845
Provider Enumeration Date:
05/23/2006

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: 225100000X , with the licence number:  0272621 , 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: 11514673 . This is a "CAQH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00355266 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5361 . This is a "SIDNEY HILLMAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2579671 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P00357141 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P0140059WH . This is a "BLUE CHOICE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: FA0501 . This is a "PREFERRED CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00027338501 . This is a "UNIVERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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