1881847986 NPI number — MRS. MEGAN DANIELLE CARNEVALE MSPT

Table of content: MRS. MEGAN DANIELLE CARNEVALE MSPT (NPI 1881847986)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881847986 NPI number — MRS. MEGAN DANIELLE CARNEVALE MSPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARNEVALE
Provider First Name:
MEGAN
Provider Middle Name:
DANIELLE
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:
DISANTO
Provider Other First Name:
MEGAN
Provider Other Middle Name:
DANIELLE
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:
1881847986
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
159 W 1ST ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OSWEGO
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13126-2045
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-342-9575
Provider Business Mailing Address Fax Number:
315-342-7664

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1529 NYE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LYONS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14489-9111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-946-5673
Provider Business Practice Location Address Fax Number:
315-946-5850
Provider Enumeration Date:
11/03/2008

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:  026494-1 , 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)





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