1992961973 NPI number — PHILIPS AUTISM THERAPY CENTER INC

Table of content: RYAN NICHOLAS MADDEN MD (NPI 1275237612)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992961973 NPI number — PHILIPS AUTISM THERAPY CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHILIPS AUTISM THERAPY CENTER INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1992961973
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/18/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7777 N WICKHAM RD
Provider Second Line Business Mailing Address:
SUITE 12-309
Provider Business Mailing Address City Name:
MELBOURNE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32940-7976
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-554-6558
Provider Business Mailing Address Fax Number:
321-757-5177

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2075 MEADOWLANE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
W. MELBOURNE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-554-6558
Provider Business Practice Location Address Fax Number:
321-757-5177
Provider Enumeration Date:
07/30/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DECARO
Authorized Official First Name:
FRANK
Authorized Official Middle Name:
P
Authorized Official Title or Position:
OWNER/CEO
Authorized Official Telephone Number:
321-432-9418

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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