1811038854 NPI number — DANIELLE MELISSA BEIDLEMAN M.D.

Table of content: DANIELLE MELISSA BEIDLEMAN M.D. (NPI 1811038854)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811038854 NPI number — DANIELLE MELISSA BEIDLEMAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEIDLEMAN
Provider First Name:
DANIELLE
Provider Middle Name:
MELISSA
Provider Name Prefix Text:
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:
ARUZ
Provider Other First Name:
DANIELLE
Provider Other Middle Name:
MELISSA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1811038854
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
362 DEMOTT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TEANECK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07666-3128
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
347-482-7422
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
703 MAIN ST
Provider Second Line Business Practice Location Address:
DEPARTMENT OF OB/GYN
Provider Business Practice Location Address City Name:
PATERSON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07503-2621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-754-2700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/11/2007

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: 207V00000X , with the licence number:  242460 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207V00000X , with the licence number: #25MA08431400 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 02851976 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".