1841287927 NPI number — MR. LYNDON SCOTT GRITTERS MD

Table of content: MR. LYNDON SCOTT GRITTERS MD (NPI 1841287927)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841287927 NPI number — MR. LYNDON SCOTT GRITTERS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRITTERS
Provider First Name:
LYNDON
Provider Middle Name:
SCOTT
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1841287927
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/12/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15 S MAIN ST STE 250
Provider Second Line Business Mailing Address:
P O BOX 788
Provider Business Mailing Address City Name:
JAMESTOWN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14701-6627
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-664-9731
Provider Business Mailing Address Fax Number:
716-664-9160

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
207 FOOTE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JAMESTOWN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14701-7077
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-487-0141
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/04/2005

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: 2085R0202X , with the licence number:  203058 , 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: 01658635 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300065047 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2030583CR . This is a "WORKERS COMPENSATION" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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