1144627894 NPI number — MR. LUDNER HENRI SR. CNA212386

Table of content: RUTH GROSSINGER (NPI 1265208045)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144627894 NPI number — MR. LUDNER HENRI SR. CNA212386

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HENRI
Provider First Name:
LUDNER
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
SR.
Provider Credential Text:
CNA212386
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:
1144627894
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
841 SW DURHAM TER
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORT SAINT LUCIE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34953-1547
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-289-3730
Provider Business Mailing Address Fax Number:
772-618-6561

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
841 SW DURHAM TERR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT SAINT LUCIE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34953
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-289-3730
Provider Business Practice Location Address Fax Number:
772-618-6561
Provider Enumeration Date:
11/24/2014

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: 376K00000X , with the licence number:  CNA212386 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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