1881991529 NPI number — GFN PSYCHOLOGICAL SERVICES, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881991529 NPI number — GFN PSYCHOLOGICAL SERVICES, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GFN PSYCHOLOGICAL SERVICES, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1881991529
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6701 MANLIUS CENTER RD
Provider Second Line Business Mailing Address:
SUITE 111-192
Provider Business Mailing Address City Name:
EAST SYRACUSE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13057-2999
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-218-6377
Provider Business Mailing Address Fax Number:
315-218-6377

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6701 MANLIUS CENTER RD
Provider Second Line Business Practice Location Address:
SUITE 111-192
Provider Business Practice Location Address City Name:
EAST SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13057-2999
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-218-6377
Provider Business Practice Location Address Fax Number:
315-218-6377
Provider Enumeration Date:
02/15/2011

Additional Information

Authorized Official

Authorized Official Last Name:
NNAJI
Authorized Official First Name:
THEODORE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
937-304-5930

Provider Taxonomy Codes

  • Taxonomy code: 261QM0850X , with the licence number:  018892 , 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: 1154623395 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2026 www.npivalidator.com