1447463229 NPI number — DR. ELLEN BUTENSKY JAMES PHD, PNP

Table of content: PETER M KUMPITCH OD (NPI 1063630887)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447463229 NPI number — DR. ELLEN BUTENSKY JAMES PHD, PNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JAMES
Provider First Name:
ELLEN
Provider Middle Name:
BUTENSKY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD, PNP
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:
1447463229
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
747 52ND ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAKLAND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94609-1809
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-428-3885
Provider Business Mailing Address Fax Number:
510-450-5813

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
747 52ND STREET
Provider Second Line Business Practice Location Address:
OPC 1ST FLOOR
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-428-3885
Provider Business Practice Location Address Fax Number:
510-450-5877
Provider Enumeration Date:
05/08/2007

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: 363LP0200X , with the licence number:  NP10228 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 163WP0200X , with the licence number: 547786 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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