1053732115 NPI number — KELSEY SCHULMAN

Table of content: KELSEY SCHULMAN (NPI 1053732115)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053732115 NPI number — KELSEY SCHULMAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHULMAN
Provider First Name:
KELSEY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1053732115
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/20/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
68 SOUTH SERVICE ROAD
Provider Second Line Business Mailing Address:
SUITE 350
Provider Business Mailing Address City Name:
MELVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11747
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-945-3107
Provider Business Mailing Address Fax Number:
516-945-3131

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3998 FAIR RIDGE DR
Provider Second Line Business Practice Location Address:
SUITE 320
Provider Business Practice Location Address City Name:
FAIRFAX
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22033-2907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-295-9360
Provider Business Practice Location Address Fax Number:
703-295-9369
Provider Enumeration Date:
12/16/2013

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: 367500000X , with the licence number:  R187906 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 0024171489 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

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




Copyright © 2007-2025 www.npivalidator.com