1659797942 NPI number — BENJAMIN TROENDLY

Table of content: BENJAMIN TROENDLY (NPI 1659797942)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659797942 NPI number — BENJAMIN TROENDLY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TROENDLY
Provider First Name:
BENJAMIN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1659797942
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/21/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
835 KENILWORTH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COSHOCTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43812-2367
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
855-692-7247
Provider Business Mailing Address Fax Number:
855-692-7247

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1225 WOODLAWN AVE
Provider Second Line Business Practice Location Address:
SUITE 112
Provider Business Practice Location Address City Name:
CAMBRIDGE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43725-3094
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
855-692-7247
Provider Business Practice Location Address Fax Number:
855-692-7247
Provider Enumeration Date:
03/11/2014

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: 101YA0400X , with the licence number:  ICDC.121149-CS , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: I.1500230 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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