1720304058 NPI number — SANTHAMMA VAIDIAN REGISTERED NURSE

Table of content: SANTHAMMA VAIDIAN REGISTERED NURSE (NPI 1720304058)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720304058 NPI number — SANTHAMMA VAIDIAN REGISTERED NURSE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VAIDIAN
Provider First Name:
SANTHAMMA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
REGISTERED NURSE
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:
1720304058
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/12/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 ACORN TER
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW CITY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10956-5902
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-323-4468
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
719 W NYACK RD
Provider Second Line Business Practice Location Address:
VILLAGE SQ,SUITE 27
Provider Business Practice Location Address City Name:
WEST NYACK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10994-2240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-358-2002
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/12/2010

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: 163W00000X , with the licence number:  441829-1 , 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)





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