1295869055 NPI number — MS. JOELLEN ANDERSON NP

Table of content: MS. JOELLEN ANDERSON NP (NPI 1295869055)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295869055 NPI number — MS. JOELLEN ANDERSON NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDERSON
Provider First Name:
JOELLEN
Provider Middle Name:
Provider Name Prefix Text:
MS.
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:
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:
1295869055
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:
1400 DEWEY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH BELLMORE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11710-2131
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-783-1947
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4 PHYLLIS DR
Provider Second Line Business Practice Location Address:
STE H
Provider Business Practice Location Address City Name:
PATCHOGUE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11772-2900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-447-7560
Provider Business Practice Location Address Fax Number:
631-774-7561
Provider Enumeration Date:
03/15/2007

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: 363LP0808X , with the licence number:  F400410 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 164773 . This is a "VALUE OPTIONS GOV'T" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7482405 . This is a "VALUE OPTIONS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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