1518934900 NPI number — ROSE MARIE NAEGER MA CCC SLP

Table of content: ROSE MARIE NAEGER MA CCC SLP (NPI 1518934900)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518934900 NPI number — ROSE MARIE NAEGER MA CCC SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NAEGER
Provider First Name:
ROSE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA CCC SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BAMBER
Provider Other First Name:
ROSE
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1518934900
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/27/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5305 ABBOTT RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMBURG
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14075-1625
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-646-3210
Provider Business Mailing Address Fax Number:
716-646-6392

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
150 PLEASANT AVE
Provider Second Line Business Practice Location Address:
UNION PLEASANT ELEMENTARY SCHOOL
Provider Business Practice Location Address City Name:
HAMBURG
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14075-4828
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-646-3280
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/03/2006

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: 235Z00000X , with the licence number:  0097311 , 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: 000640165002 . This is a "BCCB" identifier . This identifiers is of the category "OTHER".
  • Identifier: 020571380 . This is a "EMPIRE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 020571380 . This is a "NORTH AMERICAN PREFERRED" identifier . This identifiers is of the category "OTHER".