1215446240 NPI number — DR. CHRISTINE O'CONNELL OD

Table of content: DR. CHRISTINE O'CONNELL OD (NPI 1215446240)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215446240 NPI number — DR. CHRISTINE O'CONNELL OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
O'CONNELL
Provider First Name:
CHRISTINE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
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:
1215446240
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/10/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
140 S WALDRON LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WYNANTSKILL
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12198-8613
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
116 WOLF RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBANY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12205-1164
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-438-8600
Provider Business Practice Location Address Fax Number:
518-438-8601
Provider Enumeration Date:
09/21/2017

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: 152W00000X , with the licence number:  TUV008595 , 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)





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