1134107600 NPI number — DR. MYRNA A SANCHEZ-LATREILLE MD

Table of content: DR. MYRNA A SANCHEZ-LATREILLE MD (NPI 1134107600)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134107600 NPI number — DR. MYRNA A SANCHEZ-LATREILLE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANCHEZ-LATREILLE
Provider First Name:
MYRNA
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
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:
SANCHEZ
Provider Other First Name:
MYRNA
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1134107600
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/25/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
183 PARK ST
Provider Second Line Business Mailing Address:
SUITE 5
Provider Business Mailing Address City Name:
MALONE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12953
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-483-0482
Provider Business Mailing Address Fax Number:
518-483-6727

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
183 PARK ST
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
MALONE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12953-1238
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-483-0482
Provider Business Practice Location Address Fax Number:
518-483-6727
Provider Enumeration Date:
01/05/2006

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: 207RH0002X , with the licence number:  184388 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0003X , with the licence number: 184388 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 184388 , 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: 01421618 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: B70244 . This is a "ALICE HYDE MEDICAL CENTER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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