1831264142 NPI number — MRS. MEGAN CATHLEEN PETTIT MS PT

Table of content: MRS. MEGAN CATHLEEN PETTIT MS PT (NPI 1831264142)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831264142 NPI number — MRS. MEGAN CATHLEEN PETTIT MS PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PETTIT
Provider First Name:
MEGAN
Provider Middle Name:
CATHLEEN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PICKERING
Provider Other First Name:
MEGAN
Provider Other Middle Name:
CATHLEEN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1831264142
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
650 HAWKINS AVE
Provider Second Line Business Mailing Address:
SUITE 7
Provider Business Mailing Address City Name:
RONKONKOMA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11780
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-981-7422
Provider Business Mailing Address Fax Number:
631-981-2490

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
650 HAWKINS AVE
Provider Second Line Business Practice Location Address:
SUITE 7
Provider Business Practice Location Address City Name:
RONKONKOMA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11780
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-981-7422
Provider Business Practice Location Address Fax Number:
631-981-2490
Provider Enumeration Date:
11/21/2006

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: 225100000X , with the licence number:  0209701 , 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)





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