1346579661 NPI number — MISS DEANNA L DICORCIA MA

Table of content: MISS DEANNA L DICORCIA MA (NPI 1346579661)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346579661 NPI number — MISS DEANNA L DICORCIA MA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DICORCIA
Provider First Name:
DEANNA
Provider Middle Name:
L
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
MA
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:
1346579661
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/22/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
95 BAYVIEW DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRICK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08723-7452
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-927-0101
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
95 BAYVIEW DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRICK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08723-7452
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-927-0101
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/16/2009

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: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YS0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1346579661 . This is a "INSURANCES" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".