1447454640 NPI number — JEAN SIMONETTI MSPT

Table of content: JEAN SIMONETTI MSPT (NPI 1447454640)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447454640 NPI number — JEAN SIMONETTI MSPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIMONETTI
Provider First Name:
JEAN
Provider Middle Name:
Provider Name Prefix Text:
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:
SIMONETTI
Provider Other First Name:
JEAN
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1447454640
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7 CARNEGIE PLZ
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHERRY HILL
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08003-1000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-407-3422
Provider Business Mailing Address Fax Number:
877-407-4329

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 KINGS HWY N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHERRY HILL
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08034-1513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-407-3422
Provider Business Practice Location Address Fax Number:
877-407-4329
Provider Enumeration Date:
06/12/2007

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: 225100000X , with the licence number:  40QA009621 , 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)