1265772735 NPI number — MRS. ELAYNE FIORELLA FORGIE GERIATRIC CARE MANAG

Table of content: MRS. ELAYNE FIORELLA FORGIE GERIATRIC CARE MANAG (NPI 1265772735)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265772735 NPI number — MRS. ELAYNE FIORELLA FORGIE GERIATRIC CARE MANAG

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FORGIE
Provider First Name:
ELAYNE
Provider Middle Name:
FIORELLA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
GERIATRIC CARE MANAG
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FORGIE
Provider Other First Name:
ELAYNE
Provider Other Middle Name:
FIORELLA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CMC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1265772735
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/21/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2328 10TH AVE N STE 601
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE WORTH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33461-6615
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-588-4545
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2328 10TH AVE N STE 601
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE WORTH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33461-6615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-588-4545
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/21/2013

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: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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