1861645533 NPI number — ANTONETTE NERY GARROVILLAS PT

Table of content: ANTONETTE NERY GARROVILLAS PT (NPI 1861645533)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861645533 NPI number — ANTONETTE NERY GARROVILLAS PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARROVILLAS
Provider First Name:
ANTONETTE
Provider Middle Name:
NERY
Provider Name Prefix Text:
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:
NERY
Provider Other First Name:
ANTONETTE
Provider Other Middle Name:
BOLUS
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1861645533
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27 SCENIC DR APT C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CROTON ON HUDSON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10520-1823
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27 SCENIC DRIVE
Provider Second Line Business Practice Location Address:
APT C
Provider Business Practice Location Address City Name:
CROTON ON HUDSON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
646-541-5125
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/28/2008

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: 2251P0200X , with the licence number:  025372-1 , 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)