1477711893 NPI number — DR. KRISTIN JOY MAREK M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477711893 NPI number — DR. KRISTIN JOY MAREK M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAREK
Provider First Name:
KRISTIN
Provider Middle Name:
JOY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1477711893
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 37
Provider Second Line Business Mailing Address:
RODENBACH LANE
Provider Business Mailing Address City Name:
BRODHEADSVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18322-9900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-992-4208
Provider Business Mailing Address Fax Number:
570-992-6117

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 OSTRUM ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BETHLEHEM
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18015-1000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-526-6048
Provider Business Practice Location Address Fax Number:
484-526-6500
Provider Enumeration Date:
06/02/2008

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: 207Q00000X , with the licence number:  4301100522 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 0101249844 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: MD450566 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 003942 . This is a "MEDICARE GROUP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com