1326091257 NPI number — BARBARA L RIEDE F.N.P.

Table of content: BARBARA L RIEDE F.N.P. (NPI 1326091257)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326091257 NPI number — BARBARA L RIEDE F.N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIEDE
Provider First Name:
BARBARA
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
F.N.P.
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:
1326091257
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/11/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
380 GUY PARK AVE
Provider Second Line Business Mailing Address:
ST. MARY'S HEALTHCARE
Provider Business Mailing Address City Name:
AMSTERDAM
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12010-1055
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-841-7430
Provider Business Mailing Address Fax Number:
518-841-7121

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
380 GUY PARK AVE
Provider Second Line Business Practice Location Address:
ST. MARY'S HEALTHCARE
Provider Business Practice Location Address City Name:
AMSTERDAM
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12010-1055
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-841-7430
Provider Business Practice Location Address Fax Number:
518-841-7121
Provider Enumeration Date:
05/19/2006

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: 363LF0000X , with the licence number:  SP003757B , 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)

  • Identifier: 02554025 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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