1518007913 NPI number — SURGICAL SOCK SHOP, INC.

Table of content: NANCY JEAN WAHLIG LCSW (NPI 1497291868)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518007913 NPI number — SURGICAL SOCK SHOP, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SURGICAL SOCK SHOP, INC.
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:
1518007913
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/14/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 JOSHUA CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONSEY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10952-3640
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-425-2617
Provider Business Mailing Address Fax Number:
845-425-5550

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27 ORCHARD ST
Provider Second Line Business Practice Location Address:
SUITE 207
Provider Business Practice Location Address City Name:
MONSEY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10952-3047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-425-2617
Provider Business Practice Location Address Fax Number:
845-425-5550
Provider Enumeration Date:
02/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SCHWARTZ
Authorized Official First Name:
DEVORAH
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
845-425-2617

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , 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: 01000345500 . This is a "AMERICHOICE OF NJ" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 38126 . This is a "UHP" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 137313 . This is a "WELLCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: G71501 . This is a "EMPIRE BLUE CROSS BLUE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01793719 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01806000 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01399866 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: A1304060 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: ANC002201 . This is a "AMERICHOICE OF NY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1000017829 . This is a "AFFINITY HEALTH PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1163582 . This is a "HORIZON NJ HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 4579434 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000412358467 . This is a "HEALTH PLUS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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