1639106867 NPI number — MS. MELONY SUE LOPARCO RPAC

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 1639106867 NPI number — MS. MELONY SUE LOPARCO RPAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOPARCO
Provider First Name:
MELONY
Provider Middle Name:
SUE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RPAC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SANDS
Provider Other First Name:
MELONY
Provider Other Middle Name:
SUE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RPAC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1639106867
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
134 HOMER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORTLAND
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13045-1206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
607-749-5708
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1104 COMMONS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORTLAND
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13045-1643
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-758-3750
Provider Business Practice Location Address Fax Number:
607-758-3754
Provider Enumeration Date:
06/26/2006

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: 363AM0700X , with the licence number:  006919-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AS0400X , with the licence number: 006919-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 1039516 , 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: 02229050 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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