1174976740 NPI number — NICOLE SAPIRO VINCKIER

Table of content: (NPI 1174976740)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174976740 NPI number — NICOLE SAPIRO VINCKIER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NICOLE SAPIRO VINCKIER
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:
1174976740
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/19/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1307 WEBSTER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48009-7090
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-726-3262
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
35046 WOODWARD AVE
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48009-0964
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-647-9860
Provider Business Practice Location Address Fax Number:
248-647-9864
Provider Enumeration Date:
07/19/2016

Additional Information

Authorized Official

Authorized Official Last Name:
SANBORN
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
R
Authorized Official Title or Position:
CO-OWNER AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
248-647-9860

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  5601007743 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com