1962789966 NPI number — POST STREET OCCUPATIONAL MEDICINE PC

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 1962789966 NPI number — POST STREET OCCUPATIONAL MEDICINE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
POST STREET OCCUPATIONAL MEDICINE PC
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:
1962789966
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2299 POST ST
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94115-3441
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-923-0992
Provider Business Mailing Address Fax Number:
415-923-1036

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 FIFER AVE
Provider Second Line Business Practice Location Address:
SUITE 130
Provider Business Practice Location Address City Name:
CORTE MADERA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94925-1134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-945-1304
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/04/2011

Additional Information

Authorized Official

Authorized Official Last Name:
GORDON
Authorized Official First Name:
LEONARD
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
415-923-0992

Provider Taxonomy Codes

  • Taxonomy code: 261QX0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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