1619966264 NPI number — MRS. ALISON MICHELLE KORTZ RPA C

Table of content: MRS. ALISON MICHELLE KORTZ RPA C (NPI 1619966264)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619966264 NPI number — MRS. ALISON MICHELLE KORTZ RPA C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KORTZ
Provider First Name:
ALISON
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RPA C
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:
1619966264
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:
1547 COLUMBIA TPKE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CASTLETON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12033-9543
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-479-4156
Provider Business Mailing Address Fax Number:
518-479-3794

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1547 COLUMBIA TPKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CASTLETON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12033-9543
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-479-4156
Provider Business Practice Location Address Fax Number:
518-479-3794
Provider Enumeration Date:
10/17/2005

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: 207N00000X , with the licence number:  0068271 , 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)