1215670674 NPI number — MRS. EMILY SARAH CIACCIO

Table of content: MRS. EMILY SARAH CIACCIO (NPI 1215670674)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215670674 NPI number — MRS. EMILY SARAH CIACCIO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CIACCIO
Provider First Name:
EMILY
Provider Middle Name:
SARAH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BERNAL
Provider Other First Name:
EMILY
Provider Other Middle Name:
SARAH
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1215670674
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/22/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
162 MADISON GDNS
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OLD BRIDGE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08857-2809
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-850-1939
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
99 NJ ROUTE 37
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOMS RIVER
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08755
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-557-8000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/14/2022

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: 163WC0200X , with the licence number:  26NR17662500 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 26NJ01317200 , 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)