1669545539 NPI number — RANDY SCOTT PENNEY CPD

Table of content: SARA LEVY (NPI 1659092518)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669545539 NPI number — RANDY SCOTT PENNEY CPD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PENNEY
Provider First Name:
RANDY
Provider Middle Name:
SCOTT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CPD
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:
1669545539
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/11/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
543 NORTH STREET
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
NEW BENFORD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02740
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-993-3450
Provider Business Mailing Address Fax Number:
508-993-3455

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
543 NORTH STREET
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
NEW BENFORD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02740
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-993-3450
Provider Business Practice Location Address Fax Number:
508-993-3455
Provider Enumeration Date:
11/16/2006

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: 222Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 224P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 401154 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1528866 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com