1225107626 NPI number — DR. MARIE T EAGAN D.C.

Table of content: DR. MARIE T EAGAN D.C. (NPI 1225107626)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225107626 NPI number — DR. MARIE T EAGAN D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EAGAN
Provider First Name:
MARIE
Provider Middle Name:
T
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
EAGAN
Provider Other First Name:
RIA
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.C.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1225107626
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8 ORCHARD FARM ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORT WASHINGTON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11050-3752
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-944-8097
Provider Business Mailing Address Fax Number:
516-883-8501

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 VANDERVENTER AVE STE 100E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT WASHINGTON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11050-3752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-944-9460
Provider Business Practice Location Address Fax Number:
516-944-9427
Provider Enumeration Date:
11/07/2006

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: 111N00000X , with the licence number:  X003730-1 , 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: CO3730-1B . This is a "WORKERS COMP. AUTHORIZATI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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