1669711354 NPI number — GREGORY M SENOFSKY MD INC

Table of content: (NPI 1669711354)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669711354 NPI number — GREGORY M SENOFSKY MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREGORY M SENOFSKY MD INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1669711354
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/31/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 55517
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VALENCIA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91385-0517
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-255-9287
Provider Business Mailing Address Fax Number:
661-255-8478

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23929 MCBEAN PKWY
Provider Second Line Business Practice Location Address:
110
Provider Business Practice Location Address City Name:
VALENCIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91355-4466
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-255-9287
Provider Business Practice Location Address Fax Number:
661-255-8478
Provider Enumeration Date:
01/31/2013

Additional Information

Authorized Official

Authorized Official Last Name:
SENOFSKY
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CEO/PRESIDENT
Authorized Official Telephone Number:
661-255-9287

Provider Taxonomy Codes

  • Taxonomy code: 2086X0206X , with the licence number:  A42817 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com