1649679234 NPI number — JEANNE SEVERE PHYSICIAN ASSISTANT

Table of content: JEANNE SEVERE PHYSICIAN ASSISTANT (NPI 1649679234)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649679234 NPI number — JEANNE SEVERE PHYSICIAN ASSISTANT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEVERE
Provider First Name:
JEANNE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHYSICIAN ASSISTANT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SEVERE
Provider Other First Name:
JEANNE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1649679234
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/19/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
202 W 102ND ST
Provider Second Line Business Mailing Address:
APT # 3EF
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10025-8700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-399-8736
Provider Business Mailing Address Fax Number:
212-316-6130

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
202 W 102ND ST
Provider Second Line Business Practice Location Address:
APT # 3EF
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10025-8700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-399-8736
Provider Business Practice Location Address Fax Number:
212-316-6130
Provider Enumeration Date:
08/19/2014

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: 363A00000X , with the licence number:  003776 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X , with the licence number: 003776 , 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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