1033198023 NPI number — SHARI FEDERBUSCH MA, OTR, CHT

Table of content: SHARI FEDERBUSCH MA, OTR, CHT (NPI 1033198023)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033198023 NPI number — SHARI FEDERBUSCH MA, OTR, CHT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FEDERBUSCH
Provider First Name:
SHARI
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, OTR, CHT
Provider Gender Code:
F

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:
1033198023
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
38 CRAGMERE OVAL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW CITY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10956-5432
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-638-2126
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
151 N MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 302
Provider Business Practice Location Address City Name:
NEW CITY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10956-3851
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-638-2728
Provider Business Practice Location Address Fax Number:
845-638-1830
Provider Enumeration Date:
01/10/2006

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: 225XH1200X , with the licence number:  3201 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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