1477576585 NPI number — DAWN K DRYDEN DPM

Table of content: DAWN K DRYDEN DPM (NPI 1477576585)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477576585 NPI number — DAWN K DRYDEN DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DRYDEN
Provider First Name:
DAWN
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
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:
1477576585
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/10/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3922 W MAIN STREET RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATAVIA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14020-9467
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-344-1677
Provider Business Mailing Address Fax Number:
585-344-2105

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3922 W MAIN STREET RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BATAVIA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14020-9467
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-344-1677
Provider Business Practice Location Address Fax Number:
585-344-2105
Provider Enumeration Date:
07/26/2006

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: 213E00000X , with the licence number:  N005507 , 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: 051203000030 . This is a "FIDELIS" identifier . This identifiers is of the category "OTHER".
  • Identifier: P010005507 . This is a "BLUE CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000525583002 . This is a "BCWNY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 480033099 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7029140 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01918212 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1400042 . This is a "PC GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8990460 . This is a "IH" identifier . This identifiers is of the category "OTHER".
  • Identifier: MDE614 . This is a "PC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000525583003 . This is a "BCWNY DME" identifier . This identifiers is of the category "OTHER".
  • Identifier: 02205076 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00020520501 . This is a "CHOICE CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1499717 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9648089 . This is a "GHI GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: G0181304190 . This is a "BLUE CHOICE GRP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000525583002 . This is a "CB" identifier . This identifiers is of the category "OTHER".




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