1376980763 NPI number — MICHELLE CYMARA CHRISTOPHER RN

Table of content: MICHELLE CYMARA CHRISTOPHER RN (NPI 1376980763)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376980763 NPI number — MICHELLE CYMARA CHRISTOPHER RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHRISTOPHER
Provider First Name:
MICHELLE
Provider Middle Name:
CYMARA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CYMARA
Provider Other First Name:
MICHELLE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1376980763
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3552 SMITH DR
Provider Second Line Business Mailing Address:
APT 16
Provider Business Mailing Address City Name:
ENDICOTT
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13760-2382
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
607-280-6543
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
516 SOUTH WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWFIELD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14867-9023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-280-6543
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/27/2013

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: 164W00000X , with the licence number:  308188 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163W00000X , with the licence number: 893032 , 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)