1952491250 NPI number — INCIYA RANGWALLA-MALICKEL DO

Table of content: INCIYA RANGWALLA-MALICKEL DO (NPI 1952491250)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952491250 NPI number — INCIYA RANGWALLA-MALICKEL DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RANGWALLA-MALICKEL
Provider First Name:
INCIYA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1952491250
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/31/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 FEDERAL ST # 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMDEN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08103-1088
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-356-4924
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 COOPER PLAZA
Provider Second Line Business Practice Location Address:
THE COOPER HOSPITALIST TEAM
Provider Business Practice Location Address City Name:
CAMDEN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08103-1438
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-342-3150
Provider Business Practice Location Address Fax Number:
856-968-8418
Provider Enumeration Date:
10/15/2006

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: 207R00000X , with the licence number:  MB077643 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208M00000X , with the licence number: 25MB07764300 , 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: 3627197 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2371176000 . This is a "AMERIHEALTH, KEYSTONE, IBC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2457199 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010006648 . This is a "AMERICHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3K6195 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 42589 . This is a "UNIVERSITY HEALTHPLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: P3408632 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".




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