1215093331 NPI number — MS. KAREN MARIE MARTIN MCMAHON M.A., CCC-A

Table of content: MS. KAREN MARIE MARTIN MCMAHON M.A., CCC-A (NPI 1215093331)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215093331 NPI number — MS. KAREN MARIE MARTIN MCMAHON M.A., CCC-A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTIN MCMAHON
Provider First Name:
KAREN
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.A., CCC-A
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MARTIN
Provider Other First Name:
KAREN
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.A., CCC-A
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1215093331
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:
176 SUNRISE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILLIAMSVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14221-4326
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-433-0611
Provider Business Mailing Address Fax Number:
716-439-8049

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
670 DAVISON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOCKPORT
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14094-5338
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-433-0611
Provider Business Practice Location Address Fax Number:
716-439-8049
Provider Enumeration Date:
01/01/2007

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: 231H00000X , with the licence number:  001401-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00030008801 . This is a "UNIVERA HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000576056006 . This is a "B.CROSS & B.SHIELD OF WNY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000580058003 . This is a "B.CROSS & B.SHIELD OF WNY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000576056007 . This is a "B.CROSS & B.SHIELD OF WNY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 9209408 . This is a "INDEPENDENT HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000580058002 . This is a "B.CROSS & B.SHIELD OF WNY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000576056008 . This is a "B.CROSS & B.SHIELD OF WNY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000580058005 . This is a "B.CROSS & B.SHIELD OF WNY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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