1881820439 NPI number — MRS. CHRISTINE ELIZABETH WALDRON MSPT

Table of content: MRS. CHRISTINE ELIZABETH WALDRON MSPT (NPI 1881820439)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881820439 NPI number — MRS. CHRISTINE ELIZABETH WALDRON MSPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALDRON
Provider First Name:
CHRISTINE
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHEWCIW
Provider Other First Name:
CHRISTINE
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1881820439
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/09/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
171 INTREPID LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SYRACUSE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13205-2548
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-437-4689
Provider Business Mailing Address Fax Number:
315-437-4698

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
171 INTREPID LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13205-2548
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-437-4689
Provider Business Practice Location Address Fax Number:
315-437-4698
Provider Enumeration Date:
06/09/2009

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: 2251P0200X , with the licence number:  031119 , 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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