1427129048 NPI number — MRS. ELIZABETH ANNE DUDDY-NAVARETTA LCSWR

Table of content: MRS. ELIZABETH ANNE DUDDY-NAVARETTA LCSWR (NPI 1427129048)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427129048 NPI number — MRS. ELIZABETH ANNE DUDDY-NAVARETTA LCSWR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUDDY-NAVARETTA
Provider First Name:
ELIZABETH
Provider Middle Name:
ANNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSWR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DUDDY-NAVARETTA
Provider Other First Name:
ELIZABETH
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1427129048
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/02/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
41 OLEETA RD.
Provider Second Line Business Mailing Address:
BILLING ONLY
Provider Business Mailing Address City Name:
MOUNT SINAI
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11766
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-929-0121
Provider Business Mailing Address Fax Number:
631-361-3706

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
538 ROUTE 25A
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
ROCKY POINT
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11778
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-929-0121
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/13/2006

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: 1041C0700X , with the licence number:  0502021 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: R050202-1 , 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: 61024702538 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 203434 . This is a "MHN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0502021N01 . This is a "HIP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 122802 . This is a "VYTRA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 271679000 . This is a "EMPIRE MAGELLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6102470253 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: P2571549 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 225296 . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com