1295871788 NPI number — DR. DONNA DETRIO ENGLISH PHD

Table of content: DR. DONNA DETRIO ENGLISH PHD (NPI 1295871788)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295871788 NPI number — DR. DONNA DETRIO ENGLISH PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ENGLISH
Provider First Name:
DONNA
Provider Middle Name:
DETRIO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DETRIO
Provider Other First Name:
DONNA
Provider Other Middle Name:
MAE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1295871788
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/13/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
58 MAGNA DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GILLETTE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07933-1417
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-604-4938
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27 MOUNTAIN BLVD
Provider Second Line Business Practice Location Address:
SUITE 10
Provider Business Practice Location Address City Name:
WARREN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07059-5605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-279-7950
Provider Business Practice Location Address Fax Number:
908-279-7948
Provider Enumeration Date:
01/30/2007

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: 103T00000X , with the licence number:  35SI00276300 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 581684078 . This is a "TAX ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 129099000 . This is a "MAGELLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 74986 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".




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