1245532795 NPI number — MS. ALISON HEATHER LOEBEL BERTONI P.T.

Table of content: MS. ALISON HEATHER LOEBEL BERTONI P.T. (NPI 1245532795)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245532795 NPI number — MS. ALISON HEATHER LOEBEL BERTONI P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOEBEL BERTONI
Provider First Name:
ALISON
Provider Middle Name:
HEATHER
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LOEBEL
Provider Other First Name:
ALISON
Provider Other Middle Name:
HEATHER
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.T.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1245532795
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/03/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 DOYLE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONG BEACH
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11561-2509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-408-8337
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25111 WELLER AVE
Provider Second Line Business Practice Location Address:
PS 138
Provider Business Practice Location Address City Name:
ROSEDALE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11422-2531
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-528-9053
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/03/2010

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: 225100000X , with the licence number:  0232751 , 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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