1407147861 NPI number — CONSUELO ROSARIO NORIEGA REYNOSO MD

Table of content: CONSUELO ROSARIO NORIEGA REYNOSO MD (NPI 1407147861)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407147861 NPI number — CONSUELO ROSARIO NORIEGA REYNOSO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NORIEGA REYNOSO
Provider First Name:
CONSUELO
Provider Middle Name:
ROSARIO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NORIEGA-ROJAS
Provider Other First Name:
CONSUELO
Provider Other Middle Name:
ROSARIO
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1407147861
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/20/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
STONY BROOK UNIVERSITY MEDICAL CENTER/C&A PSYCHIATRY
Provider Second Line Business Mailing Address:
PUTNAM HALL, SOUTH CAMPUS
Provider Business Mailing Address City Name:
STONY BROOK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11794-8790
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-632-8840
Provider Business Mailing Address Fax Number:
631-632-8953

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
STONY BROOK UNIVERSITY MEDICAL CENTER/C&A PSYCHIATRY
Provider Second Line Business Practice Location Address:
PUTNAM HALL, SOUTH CAMPUS
Provider Business Practice Location Address City Name:
STONY BROOK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11794-8790
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-632-8840
Provider Business Practice Location Address Fax Number:
631-632-8953
Provider Enumeration Date:
04/20/2011

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com