1255447579 NPI number — CARYN A BARTNIK PSY D

Table of content: CARYN A BARTNIK PSY D (NPI 1255447579)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255447579 NPI number — CARYN A BARTNIK PSY D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARTNIK
Provider First Name:
CARYN
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PSY D
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:
1255447579
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/12/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 223
Provider Second Line Business Mailing Address:
2430 BOWEN ROAD
Provider Business Mailing Address City Name:
ELMA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14059-0223
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-316-0577
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2430 BOWEN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELMA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14059-9385
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-316-0577
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/21/2006

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: 103TC0700X , with the licence number:  0125151 , 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: 000525528002 . This is a "BCBS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0007406482 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6190422 . This is a "INDEPENDENT HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02275721 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00020375901 . This is a "UNIVERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 102239362 . This is a "UNITED BEHAVIORAL HEALTH" identifier . This identifiers is of the category "OTHER".




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