1679946750 NPI number — MR. RYAN FAYLUGA ACOLICOL PT

Table of content: MR. RYAN FAYLUGA ACOLICOL PT (NPI 1679946750)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679946750 NPI number — MR. RYAN FAYLUGA ACOLICOL PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ACOLICOL
Provider First Name:
RYAN
Provider Middle Name:
FAYLUGA
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PT
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:
1679946750
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/11/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
349 BRILLANTES SUBDIVISION, GOV. RAMOS STREET
Provider Second Line Business Mailing Address:
STA. MARIA
Provider Business Mailing Address City Name:
ZAMBOANGA CITY
Provider Business Mailing Address State Name:
ZAMBOANGA DEL SUR
Provider Business Mailing Address Postal Code:
7000
Provider Business Mailing Address Country Code:
PH
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
55 LAKEVIEW AVE APT A
Provider Second Line Business Practice Location Address:
LEONIA
Provider Business Practice Location Address City Name:
LEONIA
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07605-3102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-691-5201
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/11/2015

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: 225100000X , with the licence number:  038034-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225100000X , with the licence number: PT024806 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 0019900 , registered in the state of ZZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: NA . This is a "NA" identifier . This identifiers is of the category "OTHER".




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