1699088062 NPI number — LAVAY CHRSITINE LONG STUDENT HYGIENIST

Table of content: LAVAY CHRSITINE LONG STUDENT HYGIENIST (NPI 1699088062)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699088062 NPI number — LAVAY CHRSITINE LONG STUDENT HYGIENIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LONG
Provider First Name:
LAVAY
Provider Middle Name:
CHRSITINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
STUDENT HYGIENIST
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:
1699088062
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/14/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
34 BELLVIEW DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MC KEES ROCKS
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15136-1108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-244-0316
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3501 TERRACE ST
Provider Second Line Business Practice Location Address:
UNIVERSITY OF PITTSBURGH
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15213-2523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-647-8285
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/14/2010

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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