1528102126 NPI number — DR. MATTHEW D KASNETZ PHD

Table of content: DR. MATTHEW D KASNETZ PHD (NPI 1528102126)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528102126 NPI number — DR. MATTHEW D KASNETZ PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KASNETZ
Provider First Name:
MATTHEW
Provider Middle Name:
D
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
M

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:
1528102126
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
87 STILES RD
Provider Second Line Business Mailing Address:
SUITE 106
Provider Business Mailing Address City Name:
SALEM
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03079-2899
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-893-7700
Provider Business Mailing Address Fax Number:
603-893-7331

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
87 STILES RD
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03079-2899
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-893-7700
Provider Business Practice Location Address Fax Number:
603-893-7331
Provider Enumeration Date:
02/16/2007

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: 103TC0700X , with the licence number:  461 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0518956 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: MAGELLAN BEHAVIORAL . This is a "83815000" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8000 0601 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1036669 . This is a "CIGNA BEHAVIORAL HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 004547 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".




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