1578544003 NPI number — MRS. LYNN MARIE CAMPILII P.T.

Table of content: NINA MARIE RUSSELL FNP-C (NPI 1982098869)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578544003 NPI number — MRS. LYNN MARIE CAMPILII P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAMPILII
Provider First Name:
LYNN
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WEIK
Provider Other First Name:
LYNN
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.T.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1578544003
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 DELAVERGNE AVE
Provider Second Line Business Mailing Address:
C/O CENTER FOR PHYSICAL THERAPY
Provider Business Mailing Address City Name:
WAPPINGERS FALLS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12590-1202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-297-4789
Provider Business Mailing Address Fax Number:
845-297-8596

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 DELAVERGNE AVE
Provider Second Line Business Practice Location Address:
C/O CENTER FOR PHYSICAL THERAPY
Provider Business Practice Location Address City Name:
WAPPINGERS FALLS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12590-1202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-297-4789
Provider Business Practice Location Address Fax Number:
845-297-8596
Provider Enumeration Date:
11/10/2005

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: 2251P0200X , with the licence number:  011718 , 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: Q83741 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2276693 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 833198 . This is a "MANAGED PHYSICAL NETWORK" identifier . This identifiers is of the category "OTHER".
  • Identifier: P3297941 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 437212 . This is a "MVP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5796737 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2164976 . This is a "CCN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3102532 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000409492001 . This is a "HEALTH NOW" identifier . This identifiers is of the category "OTHER".




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