1528462025 NPI number — TINA NIGHMAN-POWER

Table of content: TINA NIGHMAN-POWER (NPI 1528462025)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528462025 NPI number — TINA NIGHMAN-POWER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NIGHMAN-POWER
Provider First Name:
TINA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1528462025
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/14/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 417147
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02241-7147
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-225-5202
Provider Business Mailing Address Fax Number:
845-704-6178

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
75 SEMINARY HILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARMEL
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10512-1921
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-989-2676
Provider Business Practice Location Address Fax Number:
845-704-6178
Provider Enumeration Date:
10/14/2014

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: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 03008124 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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