1487725917 NPI number — DR. RAINER W GRUESSNER MD

Table of content: DR. RAINER W GRUESSNER MD (NPI 1487725917)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487725917 NPI number — DR. RAINER W GRUESSNER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRUESSNER
Provider First Name:
RAINER
Provider Middle Name:
W
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1487725917
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/31/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
251 SALINA MEADOWS PKWY
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
SYRACUSE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13210
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-464-2096
Provider Business Mailing Address Fax Number:
315-464-2010

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
750 EAST ADAMS ST
Provider Second Line Business Practice Location Address:
STE 2W
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-464-9535
Provider Business Practice Location Address Fax Number:
315-464-6288
Provider Enumeration Date:
11/13/2006

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: 204F00000X , with the licence number:  36718 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: 33689 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 204F00000X , with the licence number: 280878 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208600000X , with the licence number: 280878 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1712215 . This is a "MEDICA - CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2T096GR . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: HP22171 . This is a "HEALTHPARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0977264 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 101022 . This is a "UCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00435421 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 1712215 . This is a "MEDICA - PRIMARY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 213545 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 690580300 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0060697 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1009125 . This is a "PREFERREDONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 763592 . This is a "ARAZ" identifier . This identifiers is of the category "OTHER".




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