1477681963 NPI number — DR. MARIANNE SANTELL D.C.

Table of content: DR. MARIANNE SANTELL D.C. (NPI 1477681963)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477681963 NPI number — DR. MARIANNE SANTELL D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANTELL
Provider First Name:
MARIANNE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SIMONE
Provider Other First Name:
MARIANNE
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1477681963
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/14/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1625 ROCHESTER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FARMINGTON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14425-9633
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-869-5120
Provider Business Mailing Address Fax Number:
585-869-5121

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1625 ROCHESTER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FARMINGTON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14425-9633
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-869-5120
Provider Business Practice Location Address Fax Number:
585-869-5121
Provider Enumeration Date:
02/28/2007

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: 111N00000X , with the licence number:  X009868-1 , 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: P010009868 . This is a "EXCELLUS BLUE CHOICE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1477681963 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P010009868 . This is a "EXCELLUS BCBS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1477681963 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: C09868-3B . This is a "WORK COMP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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