1780826065 NPI number — JESSICA RAE TOWNSEND MA

Table of content: JESSICA RAE TOWNSEND MA (NPI 1780826065)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780826065 NPI number — JESSICA RAE TOWNSEND MA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TOWNSEND
Provider First Name:
JESSICA
Provider Middle Name:
RAE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA
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:
1780826065
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
359 BALLSTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SARATOGA SPRINGS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12866-4723
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-587-8008
Provider Business Mailing Address Fax Number:
518-587-8241

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
70 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENWICH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12834-1211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-636-0483
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/01/2009

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: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 006700 . This is a "NYS LIC" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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