1053375477 NPI number — MS. JACQUELINE PATRICIA DENNISON N.P.

Table of content: MS. JACQUELINE PATRICIA DENNISON N.P. (NPI 1053375477)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053375477 NPI number — MS. JACQUELINE PATRICIA DENNISON N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DENNISON
Provider First Name:
JACQUELINE
Provider Middle Name:
PATRICIA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
N.P.
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:
1053375477
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/27/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1050 PITTSFORD VICTOR RD
Provider Second Line Business Mailing Address:
PARKVIEW PEDIATRICS, PLLC
Provider Business Mailing Address City Name:
PITTSFORD
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14534-3812
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-383-1160
Provider Business Mailing Address Fax Number:
585-383-8945

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1050 PITTSFORD VICTOR RD
Provider Second Line Business Practice Location Address:
PARKVIEW PEDIATRICS, PLLC
Provider Business Practice Location Address City Name:
PITTSFORD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14534-3812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-383-1160
Provider Business Practice Location Address Fax Number:
585-383-8945
Provider Enumeration Date:
04/13/2006

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: 363LP0200X , with the licence number:  F381163 , 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)

  • Identifier: 109346DL . This is a "PREFERRED CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P019381163 . This is a "EXCELLUS MANAGED CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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