1528145836 NPI number — DR. TRICIA MASTROPIETRO BA DC

Table of content: DR. TRICIA MASTROPIETRO BA DC (NPI 1528145836)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528145836 NPI number — DR. TRICIA MASTROPIETRO BA DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MASTROPIETRO
Provider First Name:
TRICIA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
BA DC
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:
1528145836
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1114 RARITAN RD
Provider Second Line Business Mailing Address:
SUITE 4
Provider Business Mailing Address City Name:
CLARK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07066-1330
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-388-3828
Provider Business Mailing Address Fax Number:
732-388-3829

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1114 RARITAN RD
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
CLARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07066-1330
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-388-3828
Provider Business Practice Location Address Fax Number:
732-388-3829
Provider Enumeration Date:
11/01/2006

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: 111N00000X , with the licence number:  38MC00600800 , 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: P00192623 . This is a "RAILROAD MEDICARE #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 066781TLK . This is a "MEDICARE PROVIDER PIN #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: DC8296 . This is a "RAILROAD MEDICARE GROUP #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P2901780 . This is a "OXFORD PROVIDER #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 3698573 . This is a "AETNA PROV #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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