1780839068 NPI number — MRS. NICOLETTA SUZAN MCKEEVER M.S.P.T.

Table of content: MRS. NICOLETTA SUZAN MCKEEVER M.S.P.T. (NPI 1780839068)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780839068 NPI number — MRS. NICOLETTA SUZAN MCKEEVER M.S.P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCKEEVER
Provider First Name:
NICOLETTA
Provider Middle Name:
SUZAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S.P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LISA
Provider Other First Name:
NICOLETTA
Provider Other Middle Name:
SUZAN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.T.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1780839068
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6606 VETERANS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11234-5720
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
646-207-0536
Provider Business Mailing Address Fax Number:
718-531-7981

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6606 VETERANS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11234-5720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
646-207-0536
Provider Business Practice Location Address Fax Number:
718-531-7981
Provider Enumeration Date:
11/30/2008

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

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





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