1922058981 NPI number — DR. HAIDEE RAE GANZ-BONHURST DPT, M.S.,A.T.,C

Table of content: DR. HAIDEE RAE GANZ-BONHURST DPT, M.S.,A.T.,C (NPI 1922058981)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922058981 NPI number — DR. HAIDEE RAE GANZ-BONHURST DPT, M.S.,A.T.,C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GANZ-BONHURST
Provider First Name:
HAIDEE
Provider Middle Name:
RAE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPT, M.S.,A.T.,C
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:
1922058981
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50 ROUTE 111
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
SMITHTOWN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11787-3700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-360-0723
Provider Business Mailing Address Fax Number:
631-360-2346

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 ROUTE 111
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
SMITHTOWN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11787-3700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-360-0723
Provider Business Practice Location Address Fax Number:
631-360-2346
Provider Enumeration Date:
05/11/2006

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:  010927-1 , 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)

  • Identifier: 0003850 . This is a "INDEPENDENT HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0510681 . This is a "U.S. HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 77273 . This is a "VYTRA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 34501 . This is a "CIGNA-ORTHONET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6601841 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: ANC1171 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 129689P . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 970302 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: AZ00431A . This is a "MDNY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com