1750362539 NPI number — SCOTT E CHARNITSKY PAC

Table of content: SCOTT E CHARNITSKY PAC (NPI 1750362539)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750362539 NPI number — SCOTT E CHARNITSKY PAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHARNITSKY
Provider First Name:
SCOTT
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PAC
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:
1750362539
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/06/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7707 FANNIN
Provider Second Line Business Mailing Address:
SUITE 195
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77054
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-797-0045
Provider Business Mailing Address Fax Number:
713-797-1821

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7707 FANNIN
Provider Second Line Business Practice Location Address:
SUITE 195
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77054
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-797-0045
Provider Business Practice Location Address Fax Number:
713-797-1821
Provider Enumeration Date:
11/09/2005

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: 363AM0700X , with the licence number:  000970 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 230590 . This is a "PREFERRED ONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 290000970CT01 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2V3628 . This is a "HEALTHNET MEDICAID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2V3628 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 090970 . This is a "CONNECTICARE" identifier . This identifiers is of the category "OTHER".




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