1780624197 NPI number — DR. RICHARD JASON FOST PH.D.

Table of content: DR. RICHARD JASON FOST PH.D. (NPI 1780624197)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780624197 NPI number — DR. RICHARD JASON FOST PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FOST
Provider First Name:
RICHARD
Provider Middle Name:
JASON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
M

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:
1780624197
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
134 CRAMER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POUGHKEEPSIE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12603-6325
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-452-4949
Provider Business Mailing Address Fax Number:
845-452-8510

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12 DAVIS AVE
Provider Second Line Business Practice Location Address:
SUITE 2N
Provider Business Practice Location Address City Name:
POUGHKEEPSIE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12603-2408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-452-4949
Provider Business Practice Location Address Fax Number:
845-452-8510
Provider Enumeration Date:
06/07/2006

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: 103TC0700X , with the licence number:  012365 , 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: 243298 . This is a "VALUEOPTIONS PROVIDER ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P1017060 . This is a "OXFORD PROVIDER ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 946918 . This is a "MVP ID# (SOLE PROPRIETOR)" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01578578 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 192792 . This is a "MHN PROVIDER ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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