1770890543 NPI number — CATHERINE SCHNELL CAMPBELL PT

Table of content: (NPI 1598882656)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770890543 NPI number — CATHERINE SCHNELL CAMPBELL PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAMPBELL
Provider First Name:
CATHERINE
Provider Middle Name:
SCHNELL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SCHNELL
Provider Other First Name:
CATHERINE
Provider Other Middle Name:
PATRICIA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1770890543
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/12/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
36 W 44TH ST
Provider Second Line Business Mailing Address:
STE 403
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10036-8102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-759-2280
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
390 EMPIRE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80026-2605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-216-5128
Provider Business Practice Location Address Fax Number:
720-316-6744
Provider Enumeration Date:
09/01/2010

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: 225100000X , with the licence number:  0329391 , 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)