1063246817 NPI number — ATTUNE MARRIAGE AND FAMILY THERAPY PC

Table of content: (NPI 1063246817)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063246817 NPI number — ATTUNE MARRIAGE AND FAMILY THERAPY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ATTUNE MARRIAGE AND FAMILY THERAPY 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:
1063246817
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
205 HAMILTON PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SYRACUSE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13214-2331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-696-1360
Provider Business Mailing Address Fax Number:
315-314-7726

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6700 KIRKVILLE RD STE 107
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13057-9382
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-696-1360
Provider Business Practice Location Address Fax Number:
315-314-7726
Provider Enumeration Date:
08/26/2024

Additional Information

Authorized Official

Authorized Official Last Name:
WELDUM
Authorized Official First Name:
JILL
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
315-696-1360

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com