1285603548 NPI number — MICHAEL F LUDWIG RPA-C

Table of content: MICHAEL F LUDWIG RPA-C (NPI 1285603548)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285603548 NPI number — MICHAEL F LUDWIG RPA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUDWIG
Provider First Name:
MICHAEL
Provider Middle Name:
F
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RPA-C
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:
1285603548
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
216 E MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTFIELD
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14787-1133
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-753-7107
Provider Business Mailing Address Fax Number:
716-326-3233

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
216 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESTFIELD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14787-1133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-753-7107
Provider Business Practice Location Address Fax Number:
716-326-3233
Provider Enumeration Date:
03/17/2006

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: 363A00000X , with the licence number:  008778 , 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: 9512115 . This is a "INDEPENDENT HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000570381005 . This is a "BCBSWNY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00026521702 . This is a "UNIVERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02311080 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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