1538276415 NPI number — MR. FRANK JOHN KERSHIS PT, COMT

Table of content: MR. FRANK JOHN KERSHIS PT, COMT (NPI 1538276415)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538276415 NPI number — MR. FRANK JOHN KERSHIS PT, COMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KERSHIS
Provider First Name:
FRANK
Provider Middle Name:
JOHN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PT, COMT
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:
1538276415
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:
1010 ROUTE 112
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
PORT JEFFERSON STATION
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11776-3097
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-476-4880
Provider Business Mailing Address Fax Number:
631-476-4887

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1010 ROUTE 112
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
PORT JEFFERSON STATION
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11776-3097
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-476-4880
Provider Business Practice Location Address Fax Number:
631-476-4887
Provider Enumeration Date:
08/24/2006

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: 225100000X , with the licence number:  01570 , 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: 113628992 . This is a "TAX IDENTIFACTION NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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