1578582789 NPI number — DEBRA Q. VIRTANEN

Table of content: (NPI 1578582789)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578582789 NPI number — DEBRA Q. VIRTANEN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEBRA Q. VIRTANEN
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1578582789
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 FEDERAL ST
Provider Second Line Business Mailing Address:
SUITE 302
Provider Business Mailing Address City Name:
TROY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12180-2832
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-272-3324
Provider Business Mailing Address Fax Number:
518-274-6904

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 FEDERAL ST
Provider Second Line Business Practice Location Address:
SUITE 302
Provider Business Practice Location Address City Name:
TROY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12180-2832
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-272-3324
Provider Business Practice Location Address Fax Number:
518-274-6904
Provider Enumeration Date:
07/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VIRTANEN
Authorized Official First Name:
DEBRA
Authorized Official Middle Name:
Q
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
518-272-3324

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  005954-1 , 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: 000405280001 . This is a "BS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01097176 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5306322 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00040402301 . This is a "UNIVERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 10002115 . This is a "CDPHP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 43153 . This is a "MVP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: Q56921 . This is a "EMPIRE BC" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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