1356604011 NPI number — DR. JENNIFER ELIZABETH NEHODA CHRISTY DDS

Table of content: DR. JENNIFER ELIZABETH NEHODA CHRISTY DDS (NPI 1356604011)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356604011 NPI number — DR. JENNIFER ELIZABETH NEHODA CHRISTY DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHRISTY
Provider First Name:
JENNIFER
Provider Middle Name:
ELIZABETH NEHODA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
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:
1356604011
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/18/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3189
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SYRACUSE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13220-3189
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-273-8204
Provider Business Mailing Address Fax Number:
866-803-4943

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 SUNBURY RD
Provider Second Line Business Practice Location Address:
UNIT 712
Provider Business Practice Location Address City Name:
DELAWARE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43015-6040
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-362-5800
Provider Business Practice Location Address Fax Number:
740-362-0620
Provider Enumeration Date:
06/19/2012

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: 122300000X , with the licence number:  30.023697 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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