1669447603 NPI number — RICHARD DAVID GARNETT PH.D.

Table of content: JENNIFER A GREENWOOD (NPI 1740024561)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669447603 NPI number — RICHARD DAVID GARNETT PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARNETT
Provider First Name:
RICHARD
Provider Middle Name:
DAVID
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
M

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:
1669447603
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
133 SARATOGA RD
Provider Second Line Business Mailing Address:
PROFESSIONAL BUILDING, SUITE 3
Provider Business Mailing Address City Name:
GLENVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12302-4108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-399-4051
Provider Business Mailing Address Fax Number:
518-399-5447

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
133 SARATOGA RD
Provider Second Line Business Practice Location Address:
PROFESSIONAL BUILDING, SUITE 3
Provider Business Practice Location Address City Name:
GLENVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12302-4108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-399-4051
Provider Business Practice Location Address Fax Number:
518-399-5447
Provider Enumeration Date:
02/22/2006

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: 103TC0700X , with the licence number:  5312 , 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: 000490835001 . This is a "BLUE SHIELD NENY PROVIDE#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0005445 . This is a "GHI PROVIDER NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 41104 . This is a "MVP PROVIDER NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00712189 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 37840 . This is a "CIGNA PROVIDER NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 131941 . This is a "VALUE OPTIONS PROVIDER #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: S05312-4 . This is a "NYS WORKER'S COMP #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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