1427092899 NPI number — JAYNE BOESSMANN RPA-C

Table of content: JAYNE BOESSMANN RPA-C (NPI 1427092899)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427092899 NPI number — JAYNE BOESSMANN RPA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOESSMANN
Provider First Name:
JAYNE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RPA-C
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:
1427092899
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:
687 LEE RD
Provider Second Line Business Mailing Address:
102
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14606-4257
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-254-2594
Provider Business Mailing Address Fax Number:
585-254-2812

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
687 LEE RD
Provider Second Line Business Practice Location Address:
102
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14606-4257
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-254-2594
Provider Business Practice Location Address Fax Number:
585-254-2812
Provider Enumeration Date:
06/16/2006

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: 363AM0700X , with the licence number:  002524 , 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: 00091799600 . This is a "HEALTHNOW" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02407303 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 109051BJ . This is a "PREFERRED CARE" identifier . This identifiers is of the category "OTHER".




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