1063774180 NPI number — MS. STEPHANIE LAURA HARZEWSKI MS ED

Table of content: MS. STEPHANIE LAURA HARZEWSKI MS ED (NPI 1063774180)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063774180 NPI number — MS. STEPHANIE LAURA HARZEWSKI MS ED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARZEWSKI
Provider First Name:
STEPHANIE
Provider Middle Name:
LAURA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MS ED
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ABEL
Provider Other First Name:
STEPHANIE
Provider Other Middle Name:
LAURA
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS ED
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1063774180
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/14/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 GOLDEN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENWOOD LAKE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10925-2903
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 GOLDEN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENWOOD LAKE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10925-2903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-477-9527
Provider Business Practice Location Address Fax Number:
845-477-9527
Provider Enumeration Date:
06/14/2012

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: 174400000X , 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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