1205962354 NPI number — MRS. MERRILL SUE STAUBER MACCC

Table of content: MRS. MERRILL SUE STAUBER MACCC (NPI 1205962354)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205962354 NPI number — MRS. MERRILL SUE STAUBER MACCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STAUBER
Provider First Name:
MERRILL
Provider Middle Name:
SUE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MACCC
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:
1205962354
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/16/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
219 TAYLOR MILLS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANALAPAN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07726-3255
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-431-5093
Provider Business Mailing Address Fax Number:
732-431-5094

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
219 TAYLOR MILLS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANALAPAN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07726-3255
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-431-5093
Provider Business Practice Location Address Fax Number:
732-431-5094
Provider Enumeration Date:
02/25/2007

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: 235Z00000X , with the licence number:  41YS00180400 , 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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