1902894090 NPI number — LINDA J HILL DO

Table of content: LINDA J HILL DO (NPI 1902894090)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902894090 NPI number — LINDA J HILL DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HILL
Provider First Name:
LINDA
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1902894090
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/02/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
665 SARATOGA RD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
GANSEVOORT
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12831-1599
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-363-8815
Provider Business Mailing Address Fax Number:
518-363-8831

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
665 SARATOGA RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
GANSEVOORT
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12831-1599
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-363-8815
Provider Business Practice Location Address Fax Number:
518-363-8831
Provider Enumeration Date:
10/12/2005

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: 207Q00000X , with the licence number:  232717 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 032-0064779 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 237029 , 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: 02694397 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2141957 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1011966 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".




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