1942265061 NPI number — DR. PERRIN D EDWARDS DPM

Table of content: DR. PERRIN D EDWARDS DPM (NPI 1942265061)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942265061 NPI number — DR. PERRIN D EDWARDS DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EDWARDS
Provider First Name:
PERRIN
Provider Middle Name:
D
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

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:
1942265061
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/29/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
751 WARREN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUDSON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12534-3016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-828-6516
Provider Business Mailing Address Fax Number:
518-828-9510

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
751 WARREN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUDSON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12534-3016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-828-6516
Provider Business Practice Location Address Fax Number:
518-828-9510
Provider Enumeration Date:
04/20/2006

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: 213E00000X , with the licence number:  N002903 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 213E00000X , with the licence number: P00001158 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 32791 . This is a "MVP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00558943 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10000555 . This is a "CDPHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 480007799 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 13721 . This is a "GHI HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: P32002 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000405556002 . This is a "BS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6202091 . This is a "GHI PPO" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com