1598990426 NPI number — MR. PATRICK JOHN MCENEANY JR. IDMT

Table of content: MR. PATRICK JOHN MCENEANY JR. IDMT (NPI 1598990426)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598990426 NPI number — MR. PATRICK JOHN MCENEANY JR. IDMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCENEANY
Provider First Name:
PATRICK
Provider Middle Name:
JOHN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
IDMT
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:
1598990426
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/21/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PSC 80
Provider Second Line Business Mailing Address:
UNIT 5142
Provider Business Mailing Address City Name:
APO
Provider Business Mailing Address State Name:
AP
Provider Business Mailing Address Postal Code:
96367-5142
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
011816117304505
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PSC 80
Provider Second Line Business Practice Location Address:
BOX 13685
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AP
Provider Business Practice Location Address Postal Code:
96367
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
01181986304750
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/21/2009

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: 1710I1003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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