1598817405 NPI number — ALICE CELIA FADDEN P.T.

Table of content: DIANA NORWICH (NPI 1114546710)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598817405 NPI number — ALICE CELIA FADDEN P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FADDEN
Provider First Name:
ALICE
Provider Middle Name:
CELIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.T.
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:
1598817405
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5188 HEALTH CAMP RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOMER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13077-8456
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
607-749-3923
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
FADDEN & ASSOCIATES PHYSICAL THERAPY, PLLC
Provider Second Line Business Practice Location Address:
242 PORT WATSON STREET
Provider Business Practice Location Address City Name:
CORTLAND
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-758-7212
Provider Business Practice Location Address Fax Number:
607-758-3416
Provider Enumeration Date:
01/18/2007

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: 225100000X , with the licence number:  007216-1 , 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: 4244901 . This is a "AETNA US HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 4123842 . This is a "MVP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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