1851594113 NPI number — ST. CLARE'S HOSPITAL DENTAL HEALTH CLINIC

Table of content: GINA FRANCES LATTANZIO APRN (NPI 1972057917)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851594113 NPI number — ST. CLARE'S HOSPITAL DENTAL HEALTH CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. CLARE'S HOSPITAL DENTAL HEALTH CLINIC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1851594113
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/05/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 MCCLELLAN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCHENECTADY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12304-1009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-347-5270
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 MCCLELLAN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCHENECTADY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12304-1009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-347-5270
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ANDREEN
Authorized Official First Name:
AVIVA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
518-347-5270

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , 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)





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