1891030672 NPI number — JAMIE BRETT MONIAK LPC

Table of content: JAMIE BRETT MONIAK LPC (NPI 1891030672)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891030672 NPI number — JAMIE BRETT MONIAK LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MONIAK
Provider First Name:
JAMIE
Provider Middle Name:
BRETT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC
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:
1891030672
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/01/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2435 RALEIGH ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUMMELSTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17036
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-623-1860
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
561 WEST CHOCOLATE AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HERSHEY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-623-1860
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/04/2012

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: 101YP2500X , with the licence number:  PC002359 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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