1316463532 NPI number — CYNTHIA M. TUCKER MS, CAT, CKTP

Table of content: CYNTHIA M. TUCKER MS, CAT, CKTP (NPI 1316463532)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316463532 NPI number — CYNTHIA M. TUCKER MS, CAT, CKTP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TUCKER
Provider First Name:
CYNTHIA
Provider Middle Name:
M.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, CAT, CKTP
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:
1316463532
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/18/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CONCORDIA COLLEGE NY
Provider Second Line Business Mailing Address:
171 WHITE PLAINS ROAD
Provider Business Mailing Address City Name:
BRONXVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10708
Provider Business Mailing Address Country Code:
US
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:
171 WHITE PLAINS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRONXVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10708-1923
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-337-9300
Provider Business Practice Location Address Fax Number:
914-395-4515
Provider Enumeration Date:
08/18/2017

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:  002340-1 , 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)





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