1073554234 NPI number — MR. ALAN NEIL SILK P.T.

Table of content: MR. ALAN NEIL SILK P.T. (NPI 1073554234)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073554234 NPI number — MR. ALAN NEIL SILK P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SILK
Provider First Name:
ALAN
Provider Middle Name:
NEIL
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
M

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:
1073554234
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8 BRADFORD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BARRINGTON
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02806-2204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-247-2226
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
167 GANO ST
Provider Second Line Business Practice Location Address:
LOWER LEVEL
Provider Business Practice Location Address City Name:
PROVIDENCE
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02906-3808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-274-4325
Provider Business Practice Location Address Fax Number:
401-274-0329
Provider Enumeration Date:
06/09/2006

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: 225100000X , with the licence number:  PT00426 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2517-9 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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