1952513566 NPI number — WAINSCOTT WALK-IN MEDICAL CARE PLLC

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 1952513566 NPI number — WAINSCOTT WALK-IN MEDICAL CARE PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WAINSCOTT WALK-IN MEDICAL CARE PLLC
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:
1952513566
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1330
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAINSCOTT
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11975-1330
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-537-1892
Provider Business Mailing Address Fax Number:
631-537-3053

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
83 WAINSCOTT NORTHWEST ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAINSCOTT
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11975-2003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-537-1892
Provider Business Practice Location Address Fax Number:
631-537-3053
Provider Enumeration Date:
05/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KERR
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
BLAKELEY
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
631-537-1892

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com