1558419903 NPI number — MRS. MARISA LEIGH BOYLE-PASCUCCI AU.D.,CCC-A

Table of content: MRS. MARISA LEIGH BOYLE-PASCUCCI AU.D.,CCC-A (NPI 1558419903)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558419903 NPI number — MRS. MARISA LEIGH BOYLE-PASCUCCI AU.D.,CCC-A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOYLE-PASCUCCI
Provider First Name:
MARISA
Provider Middle Name:
LEIGH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
AU.D.,CCC-A
Provider Gender Code:
F

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:
1558419903
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
140 LOCKWOOD AVE STE 202
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
NEW ROCHELLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10801-4908
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-576-6150
Provider Business Mailing Address Fax Number:
914-576-6037

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
140 LOCKWOOD AVE STE 202
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
NEW ROCHELLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10801-4908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-576-6150
Provider Business Practice Location Address Fax Number:
914-576-6037
Provider Enumeration Date:
01/08/2007

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: 231H00000X , with the licence number:  11713-1 , 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: 010654902 . This is a "POMCO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 010654902 . This is a "THE EMPIRE PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6995139-003 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P2720619 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 4899750 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: M7224 . This is a "EMPIRE BCBS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com