1487681029 NPI number — MS. MARY AGNES PIECHOTA A.T.,C

Table of content: MS. MARY AGNES PIECHOTA A.T.,C (NPI 1487681029)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487681029 NPI number — MS. MARY AGNES PIECHOTA A.T.,C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PIECHOTA
Provider First Name:
MARY
Provider Middle Name:
AGNES
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
A.T.,C
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:
1487681029
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
RR 3 BOX 3196
Provider Second Line Business Mailing Address:
BLUE RIDGE ROAD
Provider Business Mailing Address City Name:
SAYLORSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18353-9631
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-381-7246
Provider Business Mailing Address Fax Number:
570-839-0974

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
POCONO MOUNTAIN WEST HIGHSCHOOL
Provider Second Line Business Practice Location Address:
HC 89 BOX 2002 ROUTE 940
Provider Business Practice Location Address City Name:
POCONO SUMMITT, PA.
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18346
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-839-7121
Provider Business Practice Location Address Fax Number:
570-839-0974
Provider Enumeration Date:
06/27/2006

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: 2255A2300X , with the licence number:  RT000295A , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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