1629447271 NPI number — ERIN SHOCKEY LEMENTOWSKI PH.D.

Table of content: ERIN SHOCKEY LEMENTOWSKI PH.D. (NPI 1629447271)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629447271 NPI number — ERIN SHOCKEY LEMENTOWSKI PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEMENTOWSKI
Provider First Name:
ERIN
Provider Middle Name:
SHOCKEY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHOCKEY
Provider Other First Name:
ERIN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PH.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1629447271
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/24/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1025 NORTHERN BLVD
Provider Second Line Business Mailing Address:
SUITE 214
Provider Business Mailing Address City Name:
ROSLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11576-1506
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-466-2537
Provider Business Mailing Address Fax Number:
516-439-4936

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1025 NORTHERN BLVD
Provider Second Line Business Practice Location Address:
SUITE 214
Provider Business Practice Location Address City Name:
ROSLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11576-1506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-466-2537
Provider Business Practice Location Address Fax Number:
516-439-4936
Provider Enumeration Date:
09/24/2015

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: 103TC0700X , with the licence number:  021398 , 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)





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