1083992978 NPI number — JENNIFER LORAIN BATTAGLIA CNP

Table of content: JENNIFER LORAIN BATTAGLIA CNP (NPI 1083992978)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083992978 NPI number — JENNIFER LORAIN BATTAGLIA CNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BATTAGLIA
Provider First Name:
JENNIFER
Provider Middle Name:
LORAIN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CNP
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:
1083992978
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/23/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
951 MARINERS ISLAND BLVD STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN MATEO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94404-1560
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-285-6927
Provider Business Mailing Address Fax Number:
888-352-7383

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
951 MARINERS ISLAND BLVD STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN MATEO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94404-1560
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
772-217-4557
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/27/2011

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: 363LW0102X , with the licence number:  COA.12474 NP , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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