1316934268 NPI number — DR. CAROL M KREHEL 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 1316934268 NPI number — DR. CAROL M KREHEL DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KREHEL
Provider First Name:
CAROL
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
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:
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:
1316934268
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5156 S MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MUNNSVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13409-4058
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-495-2100
Provider Business Mailing Address Fax Number:
315-495-2100

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5156 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MUNNSVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13409-4058
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-495-2100
Provider Business Practice Location Address Fax Number:
315-495-2100
Provider Enumeration Date:
10/05/2005

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:  020061 , 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: 9672512 . This is a "GHI" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 0007368503 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 161609585-01 . This is a "PRISM" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 10069572 . This is a "CDPHP" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 435882 . This is a "MVP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: CAA1629 . This is a "FIRST UNITED AMERICAN LIF" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0186634 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 16-1609585-002 . This is a "RMSCO" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".




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