1770807489 NPI number — STEPHEN KREITZER MD PA

Table of content: (NPI 1770807489)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770807489 NPI number — STEPHEN KREITZER MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STEPHEN KREITZER MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1770807489
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2919 W SWANN AVE
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33609-4038
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-877-5337
Provider Business Mailing Address Fax Number:
813-872-0284

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2919 W SWANN AVE
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33609-4038
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-877-5337
Provider Business Practice Location Address Fax Number:
813-872-0284
Provider Enumeration Date:
03/24/2010

Additional Information

Authorized Official

Authorized Official Last Name:
KREITZER
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
MORDECAI
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
813-877-5337

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X , with the licence number:  ME0022412 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RS0012X , with the licence number: ME0022412 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 290015002 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 29895 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 037176900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 21066038 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com