1487646493 NPI number — ANDREW R RESLER DPM

Table of content: ANDREW R RESLER DPM (NPI 1487646493)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487646493 NPI number — ANDREW R RESLER DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RESLER
Provider First Name:
ANDREW
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
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:
1487646493
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 LITTLE BRITAIN RD
Provider Second Line Business Mailing Address:
STE 101
Provider Business Mailing Address City Name:
NEWBURGH
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12550-5100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-562-1271
Provider Business Mailing Address Fax Number:
845-562-4417

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 LITTLE BRITAIN RD
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
NEWBURGH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12550-5100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-562-1271
Provider Business Practice Location Address Fax Number:
845-562-4417
Provider Enumeration Date:
08/16/2005

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: 213ES0131X , with the licence number:  N0-03113 , 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: 00584372 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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