1871770958 NPI number — MISS COLLENE LOUISE MERLINO CONIGLIO ATC

Table of content: MISS COLLENE LOUISE MERLINO CONIGLIO ATC (NPI 1871770958)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871770958 NPI number — MISS COLLENE LOUISE MERLINO CONIGLIO ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CONIGLIO
Provider First Name:
COLLENE
Provider Middle Name:
LOUISE MERLINO
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
ATC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MERLINO
Provider Other First Name:
COLLENE
Provider Other Middle Name:
LOUISE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
ATC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1871770958
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/18/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2540 SHERIDAN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TONAWANDA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14150-9410
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-862-0567
Provider Business Mailing Address Fax Number:
716-862-0571

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2540 SHERIDAN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TONAWANDA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14150-9410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-862-0567
Provider Business Practice Location Address Fax Number:
716-862-0571
Provider Enumeration Date:
01/30/2008

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: 2255A2300X , with the licence number:  001607-1 , 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)





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