NPI |
1609029693 |
The name of the organization provider. If the provider is an organization, this is the legal business name. |
Entity Type Code |
1 |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider Last Name Legal Name |
COMBES |
The city name in the location address of the provider being identified. |
Provider First Name |
SARA |
The State code in the location of the provider
being identified. |
Provider Middle Name |
JANE |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Provider Credential Text |
L.C.S.W. |
The country code in the location address of the provider being identified. |
Provider First Line Business Practice Location Address |
251 WASHINGTON AVENUE EXT |
The telephone number associated with the location address of the provider being identified. |
Provider Business Practice Location Address City Name |
ALBANY |
The city name in the location address of the provider being identified. |
Provider Business Practice Location Address State Name |
NY |
The date the provider was assigned a unique identifier (assigned an NPI). |
Provider Business Practice Location Address Postal Code |
122055504 |
|
Provider Business Practice Location Address Country Code If outside U S |
US |
The country code in the location address of the provider being identified. |
Provider Business Practice Location Address Telephone Number |
5184564466 |
The first name of the authorized official. |
Provider Enumeration Date |
11/4/2008 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Last Update Date |
11/4/2008 |
The 10-position telephone number of the authorized official. |
Provider Gender Code |
F |
The code designating the provider’s gender if the provider is a person. |
Healthcare Provider Taxonomy Code 1 |
104100000X |
|
Provider License Number 1 |
073604 |
|
Provider License Number State Code 1 |
NY |
|
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
Healthcare Provider Taxonomy Code 2 |
1041S0200X |
|
Provider License Number 2 |
073604 |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
Provider License Number State Code 2 |
NY |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
Healthcare Provider Primary Taxonomy Switch 2 |
N |
|
Is Sole Proprietor |
N |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |