1831398882 NPI number — SUSAN MCCOY LLC

Table of content: (NPI 1831398882)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831398882 NPI number — SUSAN MCCOY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUSAN MCCOY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1831398882
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/29/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
601 EWING ST
Provider Second Line Business Mailing Address:
STE. C-13
Provider Business Mailing Address City Name:
PRINCETON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08540-2757
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-924-6899
Provider Business Mailing Address Fax Number:
609-924-5759

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 EWING ST
Provider Second Line Business Practice Location Address:
STE. C-13
Provider Business Practice Location Address City Name:
PRINCETON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08540-2757
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-924-6899
Provider Business Practice Location Address Fax Number:
609-924-5759
Provider Enumeration Date:
07/11/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MCCOY
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
NAN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
609-924-6899

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  MA39253 , 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)