1669471785 NPI number — MR. MARCUS FRANK KLEMMT CPO, FAAOP

Table of content: MR. MARCUS FRANK KLEMMT CPO, FAAOP (NPI 1669471785)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669471785 NPI number — MR. MARCUS FRANK KLEMMT CPO, FAAOP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KLEMMT
Provider First Name:
MARCUS
Provider Middle Name:
FRANK
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
CPO, FAAOP
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:
1669471785
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/10/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
130 OAKDALE ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JOHNSON CITY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13790
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
607-770-4400
Provider Business Mailing Address Fax Number:
607-770-4422

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 OAKDALE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOHNSON CITY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13790-1758
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-770-4400
Provider Business Practice Location Address Fax Number:
607-770-4422
Provider Enumeration Date:
07/20/2005

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: 1744P3200X , 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: 00432504 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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