1780775486 NPI number — BENITA NANNETTE HAMILTON RPA-C

Table of content: BENITA NANNETTE HAMILTON RPA-C (NPI 1780775486)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780775486 NPI number — BENITA NANNETTE HAMILTON RPA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAMILTON
Provider First Name:
BENITA
Provider Middle Name:
NANNETTE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RPA-C
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:
1780775486
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/30/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21 ORCHARD ST
Provider Second Line Business Mailing Address:
PO BOX 987
Provider Business Mailing Address City Name:
MIDDLETOWN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10940-5004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-343-7619
Provider Business Mailing Address Fax Number:
845-343-5390

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
53 GIBSON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GOSHEN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10924-6709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-343-7614
Provider Business Practice Location Address Fax Number:
845-343-5390
Provider Enumeration Date:
09/27/2006

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: 363A00000X , with the licence number:  005769-1 , 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)

  • Identifier: 00355931 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com