1932161460 NPI number — ELIZABETH DANFORTH MORNINGSTAR M.D.

Table of content: MRS. SHANNON MARIE MOUNTAIN-RAY LICSW (NPI 1649419318)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932161460 NPI number — ELIZABETH DANFORTH MORNINGSTAR M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORNINGSTAR
Provider First Name:
ELIZABETH
Provider Middle Name:
DANFORTH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1932161460
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:
1815 CLINTON AVE S
Provider Second Line Business Mailing Address:
SUITE 610
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14618-5720
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-244-3430
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1815 CLINTON AVE S
Provider Second Line Business Practice Location Address:
SUITE 610
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14618-5720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-244-3430
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/02/2006

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: 207V00000X , with the licence number:  138026 , 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: 6178 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000916649003 . This is a "BC/BS OF WESTERN NEW YORK" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00469329 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000916649001 . This is a "BC/BS OF WESTERN NEW YORK" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 010138026 . This is a "BLUE CHOICE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000916649002 . This is a "BC/BS OF WESTERN NEW YORK" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 9526693 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 102318CK . This is a "PREFERRED CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 160009305 . This is a "RAILROAD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5543325 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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