1649491994 NPI number — BETSY UTNICK NYS LIC. OPTICIAN

Table of content: (NPI 1457870669)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649491994 NPI number — BETSY UTNICK NYS LIC. OPTICIAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
UTNICK
Provider First Name:
BETSY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NYS LIC. OPTICIAN
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:
1649491994
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:
7 CHIMNEY RIDGE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARRIMAN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10926-3617
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-783-0234
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
475 STATE ROUTE 17M
Provider Second Line Business Practice Location Address:
PLAZA OPTICAL
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10950-4169
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-783-4400
Provider Business Practice Location Address Fax Number:
845-782-4041
Provider Enumeration Date:
05/02/2007

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: 156FC0801X , with the licence number:  C005082-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 156FX1800X , with the licence number: C50082-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)





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