1346337870 NPI number — MS. SUSAN H KAVANAGH M.S. CCC/A

Table of content: MS. SUSAN H KAVANAGH M.S. CCC/A (NPI 1346337870)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346337870 NPI number — MS. SUSAN H KAVANAGH M.S. CCC/A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KAVANAGH
Provider First Name:
SUSAN
Provider Middle Name:
H
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.S. CCC/A
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:
1346337870
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:
229 E 4TH ST
Provider Second Line Business Mailing Address:
APT.#2
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10009-7229
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-777-4966
Provider Business Mailing Address Fax Number:
212-777-7575

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 CHAMBERS ST
Provider Second Line Business Practice Location Address:
4TH FLOOR
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10007-1001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-791-2126
Provider Business Practice Location Address Fax Number:
212-406-4765
Provider Enumeration Date:
10/06/2006

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: 231H00000X , with the licence number:  001927-1 , 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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