1295048262 NPI number — MRS. SUSAN MARIE BOCHNOVICH ANDERSON DPT

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 1295048262 NPI number — MRS. SUSAN MARIE BOCHNOVICH ANDERSON DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOCHNOVICH ANDERSON
Provider First Name:
SUSAN
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BOCHNOVICH
Provider Other First Name:
SUSAN
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1295048262
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/15/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
423 SCRANTON CARBONDALE HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCRANTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18508-1115
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-207-5502
Provider Business Mailing Address Fax Number:
570-207-5511

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
423 SCRANTON CARBONDALE HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCRANTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18508-1115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-207-5502
Provider Business Practice Location Address Fax Number:
570-207-5511
Provider Enumeration Date:
07/20/2010

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:  PT020767 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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