1508904665 NPI number — CORNE, HARTOG, KATZ AND MINSKY

Table of content: (NPI 1508904665)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508904665 NPI number — CORNE, HARTOG, KATZ AND MINSKY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CORNE, HARTOG, KATZ AND MINSKY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1508904665
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2006 DWIGHT WAY
Provider Second Line Business Mailing Address:
#101
Provider Business Mailing Address City Name:
BERKELEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94704-2633
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-848-8700
Provider Business Mailing Address Fax Number:
510-848-8778

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2006 DWIGHT WAY
Provider Second Line Business Practice Location Address:
#101
Provider Business Practice Location Address City Name:
BERKELEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94704-2633
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-848-8700
Provider Business Practice Location Address Fax Number:
510-848-8778
Provider Enumeration Date:
02/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KATZ
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
EDWARD
Authorized Official Title or Position:
CO-OWNER
Authorized Official Telephone Number:
510-848-8700

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  PSY5981 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 106H00000X , with the licence number: MFC18394 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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





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