1881921070 NPI number — DR. JANET A SOBCZAK PHD., PMHNP-BC, RN

Table of content: DR. JANET A SOBCZAK PHD., PMHNP-BC, RN (NPI 1881921070)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881921070 NPI number — DR. JANET A SOBCZAK PHD., PMHNP-BC, RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOBCZAK
Provider First Name:
JANET
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD., PMHNP-BC, RN
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:
1881921070
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/20/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7270 BUCKLEY RD STE 2
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:
13212-2649
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-452-0485
Provider Business Mailing Address Fax Number:
315-452-0491

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12 ALFRED ST STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOBURN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01801-1915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-646-0500
Provider Business Practice Location Address Fax Number:
781-646-7130
Provider Enumeration Date:
11/09/2009

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: 363LP0808X , with the licence number:  RN180847 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1336163963 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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