1962491977 NPI number — JONNA A LAMARCO PT

Table of content: JONNA A LAMARCO PT (NPI 1962491977)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962491977 NPI number — JONNA A LAMARCO PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAMARCO
Provider First Name:
JONNA
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
AIELLO
Provider Other First Name:
JONNA
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1962491977
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/09/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
679 STARK TER
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALLSTON SPA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12020-3073
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-588-9434
Provider Business Mailing Address Fax Number:
518-587-2567

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
679 STARK TER
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALLSTON SPA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12020-3073
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-588-9434
Provider Business Practice Location Address Fax Number:
518-587-2567
Provider Enumeration Date:
10/21/2005

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

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

  • Identifier: 1099729 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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