1538364013 NPI number — MS. JEAN KITTELBERGER JOYCE PAC

Table of content: MS. JEAN KITTELBERGER JOYCE PAC (NPI 1538364013)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538364013 NPI number — MS. JEAN KITTELBERGER JOYCE PAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KITTELBERGER JOYCE
Provider First Name:
JEAN
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PAC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KITTELBERGER
Provider Other First Name:
JEAN
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PAC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1538364013
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:
233 WARDWELL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINEOLA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11501-2223
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-742-0511
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15211 89TH AVE
Provider Second Line Business Practice Location Address:
CARITAS HEALTH CARE
Provider Business Practice Location Address City Name:
JAMAICA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11432-3730
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-558-7079
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/15/2007

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: 363A00000X , with the licence number:  004277-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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