1790781227 NPI number — DR. SHARINE M DYMES DC

Table of content: DR. SHARINE M DYMES DC (NPI 1790781227)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790781227 NPI number — DR. SHARINE M DYMES DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DYMES
Provider First Name:
SHARINE
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
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:
1790781227
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2403 STATE ROUTE 7
Provider Second Line Business Mailing Address:
STE 5
Provider Business Mailing Address City Name:
COBLESKILL
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12043-5740
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-234-4316
Provider Business Mailing Address Fax Number:
518-234-4316

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2403 STATE ROUTE 7
Provider Second Line Business Practice Location Address:
STE 5
Provider Business Practice Location Address City Name:
COBLESKILL
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12043-5740
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-234-4316
Provider Business Practice Location Address Fax Number:
518-234-4316
Provider Enumeration Date:
06/21/2005

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: 111N00000X , with the licence number:  X007619 , 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: X64621 . This is a "BCBS #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5802966 . This is a "GHI#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01207000 . This is a "BCBS UTICA-WATERTOWN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 10022105 . This is a "CDPHP#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: CO7619-2 . This is a "WCB#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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