1497761431 NPI number — SUZAMIE JO FARNSWORTH DO

Table of content: SUZAMIE JO FARNSWORTH DO (NPI 1497761431)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497761431 NPI number — SUZAMIE JO FARNSWORTH DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FARNSWORTH
Provider First Name:
SUZAMIE
Provider Middle Name:
JO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1497761431
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 COULTER ROAD
Provider Second Line Business Mailing Address:
CLIFTON SPRINGS HOSP CLIN ATTN MEDICAL STAFF OFFICE
Provider Business Mailing Address City Name:
CLIFTON SPRINGS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14432
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-462-0486
Provider Business Mailing Address Fax Number:
315-462-2487

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 COULTER ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLIFTON SPRINGS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14432
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-462-0486
Provider Business Practice Location Address Fax Number:
315-462-2487
Provider Enumeration Date:
07/31/2006

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: 208M00000X , with the licence number:  220866 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 220866 , 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: 2164978 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02164978 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00257277 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 107007BJ . This is a "PREFERRED CHOICE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P010220866 . This is a "BLUE CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P020220866 . This is a "ROCHESTER BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: P010220866 . This is a "BLUE CHOICE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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