1154794154 NPI number — COREY GEFFKEN LMP

Table of content: JANEL ALLEGRA ZOMBERG LBS (NPI 1972373538)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154794154 NPI number — COREY GEFFKEN LMP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COREY GEFFKEN LMP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1154794154
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/12/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
345 WESTFIELD ST
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
SILVERTON
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97381-1936
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-321-6033
Provider Business Mailing Address Fax Number:
503-874-4478

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
421 N WATER ST
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
SILVERTON
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97381-1645
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-321-6033
Provider Business Practice Location Address Fax Number:
503-874-4478
Provider Enumeration Date:
11/12/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GEFFKEN
Authorized Official First Name:
COREYT
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
206-321-6033

Provider Taxonomy Codes

  • Taxonomy code: 172M00000X , with the licence number:  MA00010746 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225700000X , with the licence number: 18694 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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