1225085558 NPI number — LYNDA J. CARPENITO NP

Table of content: LYNDA J. CARPENITO NP (NPI 1225085558)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225085558 NPI number — LYNDA J. CARPENITO NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARPENITO
Provider First Name:
LYNDA
Provider Middle Name:
J.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MOYET
Provider Other First Name:
LYNDA
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
NP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1225085558
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/02/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 BROADACRES DRIVE
Provider Second Line Business Mailing Address:
4TH FLOOR
Provider Business Mailing Address City Name:
BLOOMFIELD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07003-3156
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-661-8300
Provider Business Mailing Address Fax Number:
973-661-8333

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 SOUTHERN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHATHAM
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07928
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-872-6131
Provider Business Practice Location Address Fax Number:
610-872-5128
Provider Enumeration Date:
05/30/2006

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: 363L00000X , with the licence number:  TRN13056 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 26NN04564500 , 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: 100930772-001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".