1548572159 NPI number — JP VERDISCO EXERCISE HEALTH AND FITNESS INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548572159 NPI number — JP VERDISCO EXERCISE HEALTH AND FITNESS INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JP VERDISCO EXERCISE HEALTH AND FITNESS 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:
1548572159
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/12/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1305 MIDDLE COUNTRY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SELDEN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11784-2554
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-880-3810
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1305 MIDDLE COUNTRY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SELDEN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11784-2554
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-880-3810
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/12/2010

Additional Information

Authorized Official

Authorized Official Last Name:
VERDISCO
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
PAUL
Authorized Official Title or Position:
CLINICAL EXERCISE PHYSIOLOGIST
Authorized Official Telephone Number:
631-880-3810

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  0147861 , 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)





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