1154656643 NPI number — MISS PAULINA MIERZEJEWSKI MSPT

Table of content: MISS PAULINA MIERZEJEWSKI MSPT (NPI 1154656643)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154656643 NPI number — MISS PAULINA MIERZEJEWSKI MSPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MIERZEJEWSKI
Provider First Name:
PAULINA
Provider Middle Name:
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
MSPT
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:
1154656643
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/02/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
106 LOWELL RD
Provider Second Line Business Mailing Address:
APT 203
Provider Business Mailing Address City Name:
NORTH READING
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01864-1679
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-883-0031
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
106 LOWELL RD
Provider Second Line Business Practice Location Address:
APT 203
Provider Business Practice Location Address City Name:
NORTH READING
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01864-1679
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-883-0031
Provider Business Practice Location Address Fax Number:
855-232-8604
Provider Enumeration Date:
10/16/2009

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:  025578 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 21766 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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