1356416150 NPI number — MR. ERNEST A WATSON AAS, BH-HIS, ACA

Table of content: MR. ERNEST A WATSON AAS, BH-HIS, ACA (NPI 1356416150)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356416150 NPI number — MR. ERNEST A WATSON AAS, BH-HIS, ACA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WATSON
Provider First Name:
ERNEST
Provider Middle Name:
A
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
AAS, BH-HIS, ACA
Provider Gender Code:
M

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:
1356416150
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/06/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 ALBANY AVE
Provider Second Line Business Mailing Address:
SUITE G-8
Provider Business Mailing Address City Name:
KINGSTON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12401-2946
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-338-3934
Provider Business Mailing Address Fax Number:
845-338-3772

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 ALBANY AVE
Provider Second Line Business Practice Location Address:
SUITE G-8
Provider Business Practice Location Address City Name:
KINGSTON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12401-2946
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-338-3934
Provider Business Practice Location Address Fax Number:
845-338-3772
Provider Enumeration Date:
11/21/2006

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: 237700000X , with the licence number:  14000004764 , 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: 02653661 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 443850 . This is a "WELLCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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