1023047495 NPI number — PATRICIA O'BRIEN DC

Table of content: PATRICIA O'BRIEN DC (NPI 1023047495)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023047495 NPI number — PATRICIA O'BRIEN DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
O'BRIEN
Provider First Name:
PATRICIA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DC
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:
1023047495
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/02/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
321 YALE AVE
Provider Second Line Business Mailing Address:
A
Provider Business Mailing Address City Name:
STRATFORD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08084-1247
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-782-7500
Provider Business Mailing Address Fax Number:
856-782-0075

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
321 YALE AVE
Provider Second Line Business Practice Location Address:
A
Provider Business Practice Location Address City Name:
STRATFORD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08084-1247
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-782-7500
Provider Business Practice Location Address Fax Number:
856-782-0075
Provider Enumeration Date:
06/30/2006

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: 111N00000X , with the licence number:  38MC00419800 , 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: 1037744 . This is a "AMERICAN SPECALTY PIN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2364020 . This is a "AETNA HMO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0151772000 . This is a "AH, KEYSTN, PC GRP PIN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0207600000 . This is a "AH, KEYSTN, PC INDIVD PIN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2632234 . This is a "OXFORD PIN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 11081097 . This is a "CIGNA PIN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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