1922080464 NPI number — STEPHANIE T. OSIECKI MD

Table of content: STEPHANIE T. OSIECKI MD (NPI 1922080464)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922080464 NPI number — STEPHANIE T. OSIECKI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OSIECKI
Provider First Name:
STEPHANIE
Provider Middle Name:
T.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1922080464
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
264 ELM ST
Provider Second Line Business Mailing Address:
SUITES 10&12
Provider Business Mailing Address City Name:
NORTHAMPTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01060-2857
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-586-1100
Provider Business Mailing Address Fax Number:
413-584-7062

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
264 ELM ST
Provider Second Line Business Practice Location Address:
SUITES 10&12
Provider Business Practice Location Address City Name:
NORTHAMPTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01060-2857
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-586-1100
Provider Business Practice Location Address Fax Number:
413-584-7062
Provider Enumeration Date:
11/18/2005

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: 207R00000X , with the licence number:  203867 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3207749 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 042104788 . This is a "UNICARE/GIC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 14912 . This is a "HEALTH NEW ENGLAND" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: A30786 . This is a "BCBS MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 7137629 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 042104788 . This is a "NORTH AMERICAN PREFERRED" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 042104788 . This is a "NORTHEAST HEALTH DIRECT" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 042104788 . This is a "PRIVATE HEALTH CARE SYS." identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 467855 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 042104788 . This is a "CONSOLIDATED" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 042104788 . This is a "NORTHEAST HEALTHCARE ALLI" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 203867 . This is a "CONNECTICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 9560323 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 042104788 . This is a "GREAT-WEST HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: AA24783 . This is a "HARVARD PILGRIM HEALTHCAR" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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