1831356252 NPI number — MRS. SUSAN BREZNAK-HONEYCHURCH PT

Table of content: MRS. SUSAN BREZNAK-HONEYCHURCH PT (NPI 1831356252)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831356252 NPI number — MRS. SUSAN BREZNAK-HONEYCHURCH PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BREZNAK-HONEYCHURCH
Provider First Name:
SUSAN
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT
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:
1831356252
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
150 CENTRAL AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FREDONIA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14063-1136
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-366-2499
Provider Business Mailing Address Fax Number:
716-366-1667

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
150 CENTRAL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREDONIA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14063-1136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-366-2499
Provider Business Practice Location Address Fax Number:
716-366-1667
Provider Enumeration Date:
05/22/2008

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 , with the licence number:  007385-1 , 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)





Copyright © 2007-2025 www.npivalidator.com