1174838130 NPI number — KATHLEEN MANGUNAY PERGAMENT D.O., M.P.H.

Table of content: KATHLEEN MANGUNAY PERGAMENT D.O., M.P.H. (NPI 1174838130)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174838130 NPI number — KATHLEEN MANGUNAY PERGAMENT D.O., M.P.H.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PERGAMENT
Provider First Name:
KATHLEEN
Provider Middle Name:
MANGUNAY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O., M.P.H.
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:
1174838130
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/07/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
185 SOUTH ORANGE MSB, ROOM I-506,
Provider Second Line Business Mailing Address:
RUTGERS, NEW JERSEY MEDICAL SCHOOL, DEPT OF MEDICINE
Provider Business Mailing Address City Name:
NEWARK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-972-5672
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
90 BERGEN ST STE 4400
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:
07103-2425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-972-1880
Provider Business Practice Location Address Fax Number:
973-972-1879
Provider Enumeration Date:
08/15/2010

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:  265560-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 25MB09641000 , 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)





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