1083656888 NPI number — SHIRLEY MCDUFFIE CNM

Table of content: SHIRLEY MCDUFFIE CNM (NPI 1083656888)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083656888 NPI number — SHIRLEY MCDUFFIE CNM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCDUFFIE
Provider First Name:
SHIRLEY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CNM
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:
1083656888
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
741 BROADWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWARK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07104-4309
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-483-1300
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
741 BROADWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07104-4309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-483-1300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/13/2006

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: 163W00000X , with the licence number:  26NO06323700 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367A00000X , with the licence number: 25ME00023001 , 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: 1932370483 . This is a "101 LUDLOW" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1740345693 . This is a "741 BROADWAY" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 6392105 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1194996645 . This is a "444 WILLIAM ST" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1548431091 . This is a "982 BROAD ST" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1619148160 . This is a "516 BERGEN ST" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1235300799 . This is a "37 N DAY" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1972778413 . This is a "1150 SPRINGFIELD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1063683258 . This is a "751 BROADWAY" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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