1699040469 NPI number — JUDITH LOEBL

Table of content: JUDITH LOEBL (NPI 1699040469)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699040469 NPI number — JUDITH LOEBL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOEBL
Provider First Name:
JUDITH
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1699040469
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
427 38TH ST
Provider Second Line Business Mailing Address:
PS 24
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11232-2514
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-832-9366
Provider Business Mailing Address Fax Number:
718-832-9366

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
427 38TH ST
Provider Second Line Business Practice Location Address:
PS 24
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11232-2514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-832-9366
Provider Business Practice Location Address Fax Number:
718-832-9366
Provider Enumeration Date:
03/13/2012

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:  007501-1 , 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)