1114113966 NPI number — PHILIP SAUVAGEAU

Table of content: (NPI 1114113966)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114113966 NPI number — PHILIP SAUVAGEAU

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHILIP SAUVAGEAU
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:
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:
1114113966
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/14/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5320 MILITARY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEWISTON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14092-2149
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-297-7543
Provider Business Mailing Address Fax Number:
716-298-1680

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5320 MILITARY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEWISTON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14092-2149
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-297-7543
Provider Business Practice Location Address Fax Number:
716-298-1680
Provider Enumeration Date:
09/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SAUVAGEAU
Authorized Official First Name:
PHILIP
Authorized Official Middle Name:
M
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
716-297-7543

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  2054781 , 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: 02147780 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com