1669401634 NPI number — DR. CHRISTINE E BARDY PHD

Table of content: DR. CHRISTINE E BARDY PHD (NPI 1669401634)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669401634 NPI number — DR. CHRISTINE E BARDY PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARDY
Provider First Name:
CHRISTINE
Provider Middle Name:
E
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

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:
1669401634
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/25/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
621 CAPE CORAL PKWY E STE 16
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAPE CORAL
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33904-8590
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-699-7328
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
621 CAPE CORAL PKWY E STE 16
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAPE CORAL
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33904-8590
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-699-7328
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/02/2006

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:  08775 , 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)

  • Identifier: 379864 . This is a "UNITED BEHAVIORAL HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: P3541318 . This is a "OXFORD HEALTH PLANS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 172193 . This is a "EMPIRE NYSHIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 267642 . This is a "MHN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7881740 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: VL3232 . This is a "EMPIREBLUE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6894405 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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