1457578635 NPI number — MISS POONAM HAJARE OTR

Table of content: MISS POONAM HAJARE OTR (NPI 1457578635)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457578635 NPI number — MISS POONAM HAJARE OTR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAJARE
Provider First Name:
POONAM
Provider Middle Name:
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
OTR
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:
1457578635
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/13/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
573 PRIMITIVO CT
Provider Second Line Business Mailing Address:
APT# A-2
Provider Business Mailing Address City Name:
FAIRFIELD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94534-4128
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-348-9580
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
77 MADISON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORRISTOWN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07960-7330
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-540-9800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/19/2007

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: 225X00000X , with the licence number:  46TR00420000 , 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: 46TR00420000 . This is a "OCCUPATIONAL THERAPY LIC" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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