1265506851 NPI number — PATRICIA BASZCZUK PH.D.

Table of content: PATRICIA BASZCZUK PH.D. (NPI 1265506851)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265506851 NPI number — PATRICIA BASZCZUK PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BASZCZUK
Provider First Name:
PATRICIA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
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:
1265506851
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 IRON BRIDGE RD
Provider Second Line Business Mailing Address:
6
Provider Business Mailing Address City Name:
FREEHOLD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07728-5304
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-761-2997
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
347 HOSPITAL ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALLENWOOD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-938-5250
Provider Business Practice Location Address Fax Number:
732-919-0538
Provider Enumeration Date:
11/17/2006

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: 103T00000X , with the licence number:  35SI00422700 , 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: 0067873 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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