1174516009 NPI number — DAVID J SYREK M.D.

Table of content: DAVID J SYREK M.D. (NPI 1174516009)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174516009 NPI number — DAVID J SYREK M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SYREK
Provider First Name:
DAVID
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1174516009
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:
PO BOX 24
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CANDIA
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03034-0024
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-483-2854
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 PROSPECT ST
Provider Second Line Business Practice Location Address:
2ND FL
Provider Business Practice Location Address City Name:
NASHUA
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03060-3921
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-889-4431
Provider Business Practice Location Address Fax Number:
603-889-1572
Provider Enumeration Date:
08/25/2005

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: 207ZP0102X , with the licence number:  12084 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: AA3494 . This is a "HARVARD HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01Y005220NH01 . This is a "BC/BS" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 30203860 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 467491 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0135502 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".




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