1760817464 NPI number — MISS CONSTANCE MARIE SNYDER B.S., D.T.

Table of content: MISS CONSTANCE MARIE SNYDER B.S., D.T. (NPI 1760817464)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760817464 NPI number — MISS CONSTANCE MARIE SNYDER B.S., D.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SNYDER
Provider First Name:
CONSTANCE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
B.S., D.T.
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:
1760817464
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/12/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
118 EDWARDS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTHLAKE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60164-2231
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-606-7831
Provider Business Mailing Address Fax Number:
708-409-0527

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
118 EDWARDS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTHLAKE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60164-2231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-606-7831
Provider Business Practice Location Address Fax Number:
708-409-0527
Provider Enumeration Date:
09/12/2013

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: 222Q00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com