1649323049 NPI number — DR. REBECCA A DEELEY M.D.

Table of content: DR. REBECCA A DEELEY M.D. (NPI 1649323049)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649323049 NPI number — DR. REBECCA A DEELEY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEELEY
Provider First Name:
REBECCA
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RACZYNSKI
Provider Other First Name:
REBECCA
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1649323049
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/04/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
700 QUINCY AVE
Provider Second Line Business Mailing Address:
5TH FLOOR
Provider Business Mailing Address City Name:
SCRANTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18510-1798
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-770-7546
Provider Business Mailing Address Fax Number:
570-770-7545

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 HOSPITAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UTICA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13502-2517
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-624-6000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/19/2007

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: 208000000X , with the licence number:  MD446049 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080N0001X , with the licence number: MD446049 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1027471050001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 03922507 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".