1235384496 NPI number — SAN SHIN LLC

Table of content: (NPI 1235384496)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235384496 NPI number — SAN SHIN LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAN SHIN LLC
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:
6
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:
1235384496
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15 TANGUAY AVE
Provider Second Line Business Mailing Address:
SUITE 112
Provider Business Mailing Address City Name:
NASHUA
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03063-1786
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-883-6000
Provider Business Mailing Address Fax Number:
603-883-6004

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 TANGUAY AVE
Provider Second Line Business Practice Location Address:
SUITE 112
Provider Business Practice Location Address City Name:
NASHUA
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03063-1786
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-883-6000
Provider Business Practice Location Address Fax Number:
603-883-6004
Provider Enumeration Date:
12/01/2008

Additional Information

Authorized Official

Authorized Official Last Name:
DRUCKER
Authorized Official First Name:
LEON
Authorized Official Middle Name:
ISAAC
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
603-785-6440

Provider Taxonomy Codes

  • Taxonomy code: 305R00000X , with the licence number:  03368 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 03368 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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