1326083189 NPI number — VICTORIA BIDA RPA C

Table of content: VICTORIA BIDA RPA C (NPI 1326083189)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326083189 NPI number — VICTORIA BIDA RPA C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BIDA
Provider First Name:
VICTORIA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RPA C
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:
1326083189
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/01/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
209 DAVIES AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST HENRIETTA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14586-8804
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-747-5736
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 SCIENCE PKWY
Provider Second Line Business Practice Location Address:
UNIVERSITY IMAGING AT SCIENCE PARK
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14620-4251
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-785-5000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/17/2006

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: 363AM0700X , with the licence number:  006181 , 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: 02366452 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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