1538427844 NPI number — KILLPAIN LLC

Table of content: (NPI 1538427844)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538427844 NPI number — KILLPAIN LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KILLPAIN LLC
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:
1538427844
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/18/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
498 FRENCH ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UTICA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13502-5178
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-765-8450
Provider Business Mailing Address Fax Number:
315-765-8464

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
45929 MARIES ROAD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
STERLING
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20166
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-444-5007
Provider Business Practice Location Address Fax Number:
703-444-1174
Provider Enumeration Date:
04/25/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HAIDER
Authorized Official First Name:
NAMEER
Authorized Official Middle Name:
R
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
202-731-2577

Provider Taxonomy Codes

  • Taxonomy code: 208VP0014X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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