1558316059 NPI number — NANETTE LAMM TREADWELL R.P.A.C.

Table of content: NANETTE LAMM TREADWELL R.P.A.C. (NPI 1558316059)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558316059 NPI number — NANETTE LAMM TREADWELL R.P.A.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TREADWELL
Provider First Name:
NANETTE
Provider Middle Name:
LAMM
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
R.P.A.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TREADWELL
Provider Other First Name:
NANETTE
Provider Other Middle Name:
DOROTHY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
R.P.A.C.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1558316059
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 41
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH KORTRIGHT
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13842-0041
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
607-538-1307
Provider Business Mailing Address Fax Number:
845-586-3411

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7571 NY-54
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BATH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-776-8522
Provider Business Practice Location Address Fax Number:
845-586-3411
Provider Enumeration Date:
05/23/2006

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: 363A00000X , with the licence number:  004508 , 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: 02458991 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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