1700933405 NPI number — SHOSHANA E. ENGLARD MD PA

Table of content: (NPI 1700933405)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700933405 NPI number — SHOSHANA E. ENGLARD MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHOSHANA E. ENGLARD MD PA
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:
MAPLEWOOD OPHTHALMOLOGY
Provider Other Organization Name Type Code:
4
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:
1700933405
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
614 PORTLAND AVE
Provider Second Line Business Mailing Address:
SUITE #108
Provider Business Mailing Address City Name:
SAINT PAUL
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55102-2223
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-770-2807
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1835 COUNTY ROAD C W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROSEVILLE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55113-1352
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-770-2807
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ENGLARD-FALCONER
Authorized Official First Name:
SHOSHANA
Authorized Official Middle Name:
ESTHER
Authorized Official Title or Position:
PHYSICIAN OWNER
Authorized Official Telephone Number:
651-770-2807

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  28856 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 96333 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: D672 . This is a "U CARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 109366 . This is a "CHOICE PLUS" identifier , issued by the state of ( FM ) . This identifiers is of the category "OTHER".
  • Identifier: 22262EN . This is a "BLUE CROSS SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 4023 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: DD4429 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 08-14714 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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