1588751457 NPI number — DR. DENEAN MARIE EMERSON D.C.

Table of content: DR. DENEAN MARIE EMERSON D.C. (NPI 1588751457)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588751457 NPI number — DR. DENEAN MARIE EMERSON D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EMERSON
Provider First Name:
DENEAN
Provider Middle Name:
MARIE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
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:
1588751457
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/24/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8 GENESEE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CUBA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14727-1121
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-968-1883
Provider Business Mailing Address Fax Number:
585-968-1883

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8 GENESEE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CUBA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14727-1121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-968-1883
Provider Business Practice Location Address Fax Number:
585-968-1883
Provider Enumeration Date:
10/10/2006

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: 111N00000X , with the licence number:  X007779 , 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: 000224698001 . This is a "BC-BS #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01 0489342 01 . This is a "PRISM HEALTH CARE PAR. #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5899852 . This is a "GHI PARTIPATING #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: C07779-4 . This is a "WORKERS' COMPENSATION" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: X007779 . This is a "LICENSE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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