1063655843 NPI number — EPILEPSY-PRALID, INC.

Table of content: (NPI 1063655843)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063655843 NPI number — EPILEPSY-PRALID, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EPILEPSY-PRALID, INC.
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:
1063655843
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/12/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 TOWNLINE CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14623-2536
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-442-6420
Provider Business Mailing Address Fax Number:
585-442-6964

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 TOWNLINE CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14623-2536
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-442-6420
Provider Business Practice Location Address Fax Number:
585-442-6964
Provider Enumeration Date:
04/09/2009

Additional Information

Authorized Official

Authorized Official Last Name:
SINSEBOX
Authorized Official First Name:
JEFF
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENTT
Authorized Official Telephone Number:
585-442-6420

Provider Taxonomy Codes

  • Taxonomy code: 251J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 03561786 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 03562636 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 03478782 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02138181 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02713019 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 03035852 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 03478755 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 03478773 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01550641 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 03532634 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02170950 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02248617 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 03561777 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02663183 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 03478764 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 03532643 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 03272566 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 03532652 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 03562287 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01736754 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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