1538311733 NPI number — SARAH EAGLE KEENAN MLYNARCZYK ATR, LCAT

Table of content: SARAH EAGLE KEENAN MLYNARCZYK ATR, LCAT (NPI 1538311733)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538311733 NPI number — SARAH EAGLE KEENAN MLYNARCZYK ATR, LCAT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MLYNARCZYK
Provider First Name:
SARAH
Provider Middle Name:
EAGLE KEENAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ATR, LCAT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KEENAN
Provider Other First Name:
SARAH
Provider Other Middle Name:
EAGLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
ATR, LCAT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1538311733
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
281 BENJAMIN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STAMFORD
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12167-2403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-843-1375
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 EAST 233RD STREET
Provider Second Line Business Practice Location Address:
MONTEFIORE MEDICAL CENTER, PSYCHIATRY, 7S
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10466
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-920-9419
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/21/2008

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: 221700000X , with the licence number:  001204 , 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)