1497081657 NPI number — DR. NORINE E. LECYN-MOHLE PH.D.

Table of content: DR. NORINE E. LECYN-MOHLE PH.D. (NPI 1497081657)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497081657 NPI number — DR. NORINE E. LECYN-MOHLE PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LECYN-MOHLE
Provider First Name:
NORINE
Provider Middle Name:
E.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MOHLE
Provider Other First Name:
NORINE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PH.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1497081657
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/19/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
231 FOREST RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAHWAH
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07430-3108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-690-6412
Provider Business Mailing Address Fax Number:
201-930-9842

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1172 E RIDGEWOOD AVE
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
RIDGEWOOD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07450-3936
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-690-6412
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/22/2009

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: 103T00000X , with the licence number:  35S100461000 , 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)





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