1386631414 NPI number — CYNTHIA POND CSW

Table of content: CYNTHIA POND CSW (NPI 1386631414)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386631414 NPI number — CYNTHIA POND CSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POND
Provider First Name:
CYNTHIA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CSW
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:
1386631414
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:
3920 LAKEVILLE GROVELAND RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GENESEO
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14454-9708
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-786-0150
Provider Business Mailing Address Fax Number:
585-786-3065

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
52 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARSAW
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14569-1326
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-786-0150
Provider Business Practice Location Address Fax Number:
585-786-3065
Provider Enumeration Date:
10/04/2005

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: 1041C0700X , 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: 000525425001 . This is a "HEALTHNOW" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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