1114175882 NPI number — MRS. NOELLE BUONGIORNO WOHLGEMUTH P.A.

Table of content: MRS. NOELLE BUONGIORNO WOHLGEMUTH P.A. (NPI 1114175882)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114175882 NPI number — MRS. NOELLE BUONGIORNO WOHLGEMUTH P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOHLGEMUTH
Provider First Name:
NOELLE
Provider Middle Name:
BUONGIORNO
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
P.A.
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:
1114175882
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/14/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 LYONS AVE.
Provider Second Line Business Mailing Address:
NEWARK BETH ISRAEL MEDICAL CENTER
Provider Business Mailing Address City Name:
NEWARK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07112
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-926-7000
Provider Business Mailing Address Fax Number:
973-926-8371

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
545 1ST AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10016-6401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
646-501-4240
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/05/2008

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 ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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