1083796908 NPI number — MRS. PATRICIA LEN GREEN COFFEY PTA

Table of content: MRS. PATRICIA LEN GREEN COFFEY PTA (NPI 1083796908)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083796908 NPI number — MRS. PATRICIA LEN GREEN COFFEY PTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GREEN COFFEY
Provider First Name:
PATRICIA
Provider Middle Name:
LEN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PTA
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:
1083796908
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6 COMMERCE 382 OLD NORTHERNER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEKALB JCT
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13630
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-287-7886
Provider Business Mailing Address Fax Number:
315-287-7886

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
342 OLD DEKALB RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANTON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-386-2647
Provider Business Practice Location Address Fax Number:
315-386-4071
Provider Enumeration Date:
10/19/2006

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: 225200000X , with the licence number:  0044671 , 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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