1396941969 NPI number — MS. PERI DANA DEGRAZIA CNM, WHNP

Table of content: MS. PERI DANA DEGRAZIA CNM, WHNP (NPI 1396941969)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396941969 NPI number — MS. PERI DANA DEGRAZIA CNM, WHNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEGRAZIA
Provider First Name:
PERI
Provider Middle Name:
DANA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CNM, WHNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JACOBSON
Provider Other First Name:
PERI
Provider Other Middle Name:
DANA
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1396941969
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/09/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
103 5TH AVE
Provider Second Line Business Mailing Address:
SUITE 3
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10003-1009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-366-4765
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
103 5TH AVE
Provider Second Line Business Practice Location Address:
THIRD FLOOR
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10003-1009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-366-4765
Provider Business Practice Location Address Fax Number:
212-229-1020
Provider Enumeration Date:
06/21/2007

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: 363LW0102X , with the licence number:  F420853-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 367A00000X , with the licence number: F001272-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: F001272-1 . This is a "CNM LICENSE NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 565709-1 . This is a "RN LICENSE NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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