1003977547 NPI number — MR. ANDREW MICHAEL BATICK DME SUPPLIER

Table of content: MR. ANDREW MICHAEL BATICK DME SUPPLIER (NPI 1003977547)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003977547 NPI number — MR. ANDREW MICHAEL BATICK DME SUPPLIER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BATICK
Provider First Name:
ANDREW
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
DME SUPPLIER
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:
1003977547
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:
1171 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRANFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06405
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-483-9414
Provider Business Mailing Address Fax Number:
203-483-9354

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1171 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRANFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-483-9414
Provider Business Practice Location Address Fax Number:
203-483-9354
Provider Enumeration Date:
12/12/2006

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: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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