1235164997 NPI number — L S GERBER DPM & C BROMLEY DPM PC

Table of content: (NPI 1235164997)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235164997 NPI number — L S GERBER DPM & C BROMLEY DPM PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
L S GERBER DPM & C BROMLEY DPM PC
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:
LEONARD S GERBER DPM & CHRISTOPHER BROMLEY DPM PC
Provider Other Organization Name Type Code:
5
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:
1235164997
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/10/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22 FAIRMONT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POUGHKEEPSIE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12603-2422
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-454-0630
Provider Business Mailing Address Fax Number:
845-454-0637

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22 FAIRMONT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POUGHKEEPSIE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12603-2422
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-454-0630
Provider Business Practice Location Address Fax Number:
845-454-0637
Provider Enumeration Date:
07/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TAYLOR
Authorized Official First Name:
MARY
Authorized Official Middle Name:
ALICE
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
845-454-0630

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  65 017501 , 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: 1396784849 . This is a "NPI: FLORENCE GABRIELLE SUMMERS DPM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1538163290 . This is a "NPI CHRISTOPHER KENT BROMLEY DPM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1538163290 . This is a "NPI: AUDRA ROCHELLE SIEGEL DPM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 30061 . This is a "TAX ID LAST 5 DIGITS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1194764639 . This is a "NPI LEONARD STUART GERBER DPM" identifier . This identifiers is of the category "OTHER".
  • Identifier: RAIL ROAD ME GRP ID . This is a "CJ2100" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1528073822 . This is a "NPI: DANY YOSEF JABBOUR DPM" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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