1750352217 NPI number — MRS. SUSAN L TOWNE PT

Table of content: MRS. SUSAN L TOWNE PT (NPI 1750352217)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750352217 NPI number — MRS. SUSAN L TOWNE PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TOWNE
Provider First Name:
SUSAN
Provider Middle Name:
L
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT
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:
1750352217
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
365 FEURA BUSH RD & 9W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLENMONT
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12077-2983
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-436-3954
Provider Business Mailing Address Fax Number:
518-436-4257

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
159 JEFFERSON HTS
Provider Second Line Business Practice Location Address:
STE D002
Provider Business Practice Location Address City Name:
CATSKILL
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-943-5370
Provider Business Practice Location Address Fax Number:
518-943-5325
Provider Enumeration Date:
01/31/2006

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: 225100000X , with the licence number:  0235491 , 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: 000404796001 . This is a "BS NENY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 410374 . This is a "MVP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10078463 . This is a "CDPHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: Q12L41 . This is a "PLS MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: Q12L41 . This is a "EMPIRE BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 11449621 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".




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