1467421396 NPI number — MRS. ROSEMARIE AGRESTA TRIGGER PT CSHE

Table of content: MRS. ROSEMARIE AGRESTA TRIGGER PT CSHE (NPI 1467421396)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467421396 NPI number — MRS. ROSEMARIE AGRESTA TRIGGER PT CSHE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRIGGER
Provider First Name:
ROSEMARIE
Provider Middle Name:
AGRESTA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT CSHE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TRIGGER
Provider Other First Name:
ROSEMARIE
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1467421396
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:
42 SARATOGA RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCOTIA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-399-0042
Provider Business Mailing Address Fax Number:
518-399-4513

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
42 SARATOGA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCOTIA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-399-0042
Provider Business Practice Location Address Fax Number:
518-399-4513
Provider Enumeration Date:
03/14/2006

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: 225100000X , with the licence number:  0060321 , 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: 01700678 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".