1346688082 NPI number — MRS. GOLDIE M JURAREL MSE.

Table of content: MRS. GOLDIE M JURAREL MSE. (NPI 1346688082)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346688082 NPI number — MRS. GOLDIE M JURAREL MSE.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JURAREL
Provider First Name:
GOLDIE
Provider Middle Name:
M
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSE.
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:
1346688082
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/04/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
61 LAUREL PARK ROAD
Provider Second Line Business Mailing Address:
APT H5
Provider Business Mailing Address City Name:
FALLSBURY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12733
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-423-8970
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
61 LAUREL PARK ROAD
Provider Second Line Business Practice Location Address:
APT H5
Provider Business Practice Location Address City Name:
FALLSBURY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12733
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-423-8970
Provider Business Practice Location Address Fax Number:
845-434-5696
Provider Enumeration Date:
06/04/2013

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: 103TC2200X , with the licence number:  217528150 , 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: ET881535 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com