1255830634 NPI number — MR. CORY CAMPOPIANO ATC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255830634 NPI number — MR. CORY CAMPOPIANO ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAMPOPIANO
Provider First Name:
CORY
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
ATC
Provider Gender Code:
M

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:
1255830634
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/11/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
39/12-16 SOI NICHADA THANI, SAMAKEE ROAD
Provider Second Line Business Mailing Address:
SAMAKEE GARDENS APT #5B
Provider Business Mailing Address City Name:
PAKKRET
Provider Business Mailing Address State Name:
NONTHABURI
Provider Business Mailing Address Postal Code:
11120
Provider Business Mailing Address Country Code:
TH
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
39/12-16 SOI NICHADA THANI, SAMAKEE ROAD
Provider Second Line Business Practice Location Address:
SAMAKEE GARDENS APT #5B
Provider Business Practice Location Address City Name:
PAKKRET
Provider Business Practice Location Address State Name:
NONTHABURI
Provider Business Practice Location Address Postal Code:
11120
Provider Business Practice Location Address Country Code:
TH
Provider Business Practice Location Address Telephone Number:
678-702-3976
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/12/2018

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: 2255A2300X , with the licence number:  2000019910 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2000019910 . This is a "BOARD OF CERTIFICATION" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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