1336152677 NPI number — KRISTINA LYNN CHALUPNICKI PT

Table of content: KRISTINA LYNN CHALUPNICKI PT (NPI 1336152677)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336152677 NPI number — KRISTINA LYNN CHALUPNICKI PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHALUPNICKI
Provider First Name:
KRISTINA
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FARRELL
Provider Other First Name:
KRISTINA
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1336152677
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:
3076 GRACIE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORTLAND
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13045-9373
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-406-3973
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MURRAY CENTER
Provider Second Line Business Practice Location Address:
823 NYS RTE 13
Provider Business Practice Location Address City Name:
CORTLAND
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-758-8850
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/15/2006

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: 225100000X , with the licence number:  028432 , 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)