1184879892 NPI number — MRS. JILL MELISSA CRONIN MSPT

Table of content: MRS. JILL MELISSA CRONIN MSPT (NPI 1184879892)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184879892 NPI number — MRS. JILL MELISSA CRONIN MSPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRONIN
Provider First Name:
JILL
Provider Middle Name:
MELISSA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GOLDMAN
Provider Other First Name:
JILL
Provider Other Middle Name:
MELISSA
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1184879892
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12 RIDGE WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PURDYS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10578
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-384-0450
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12 RIDGE WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PURDYS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10578-1404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-384-0450
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/21/2008

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: 2251P0200X , with the licence number:  015123-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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