1396703369 NPI number — CHRISTINE FORSZPANIAK INC

Table of content: (NPI 1396703369)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396703369 NPI number — CHRISTINE FORSZPANIAK INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHRISTINE FORSZPANIAK INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1396703369
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/16/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
848 1ST AVE N
Provider Second Line Business Mailing Address:
SUITE 230
Provider Business Mailing Address City Name:
NAPLES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34102-6013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-434-7779
Provider Business Mailing Address Fax Number:
239-434-7588

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
848 1ST AVE N
Provider Second Line Business Practice Location Address:
SUITE 230
Provider Business Practice Location Address City Name:
NAPLES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34102-6013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-434-7779
Provider Business Practice Location Address Fax Number:
239-434-7588
Provider Enumeration Date:
05/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FORSZPANIAK
Authorized Official First Name:
CHRISTINE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
239-434-7779

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  ME 49793 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 064785300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110050893 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: DN646A . This is a "MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: P1107159 . This is a "OXFORD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 008400100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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