1790006526 NPI number — MR. CHRISTOPHER VIAGRANDE NPP

Table of content: MR. CHRISTOPHER VIAGRANDE NPP (NPI 1790006526)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790006526 NPI number — MR. CHRISTOPHER VIAGRANDE NPP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VIAGRANDE
Provider First Name:
CHRISTOPHER
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
NPP
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:
1790006526
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/15/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15 ALBIN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DELMAR
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12054-4122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-518-7167
Provider Business Mailing Address Fax Number:
518-670-9636

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 ALBIN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DELMAR
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12054-4122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-518-7167
Provider Business Practice Location Address Fax Number:
518-670-9636
Provider Enumeration Date:
06/16/2010

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: 363LP0808X , with the licence number:  401279 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: F401279-1 , 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: 401279 . This is a "OFFICE OF THE PROFESSIONS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 826669222 . This is a "NYS DMV" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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