1962572883 NPI number — DR. ROBERT A STRANGE DC LAC

Table of content: DR. ROBERT A STRANGE DC LAC (NPI 1962572883)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962572883 NPI number — DR. ROBERT A STRANGE DC LAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STRANGE
Provider First Name:
ROBERT
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC LAC
Provider Gender Code:
M

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:
1962572883
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3 MERRITT AVE.
Provider Second Line Business Mailing Address:
PO BOX 725
Provider Business Mailing Address City Name:
MILLBROOK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12545-0725
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-677-5410
Provider Business Mailing Address Fax Number:
845-677-4163

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3 MERRITT AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILLBROOK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12545-0725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-677-5410
Provider Business Practice Location Address Fax Number:
845-677-4163
Provider Enumeration Date:
11/08/2006

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: 111N00000X , with the licence number:  X004397-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 171100000X , with the licence number: 003463-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 7233K2 . This is a "BLUECROSS/ BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 4397-8B . This is a "WORK COMP BOARD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 820148 . This is a "MANAGED PHYSICAL NETWORK" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: X32R71 . This is a "BLUE CROSS/ BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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