1366694416 NPI number — DR. MARIA VERONICA R ABELLO-POBLETE M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366694416 NPI number — DR. MARIA VERONICA R ABELLO-POBLETE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ABELLO-POBLETE
Provider First Name:
MARIA
Provider Middle Name:
VERONICA R
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ABELLO
Provider Other First Name:
MARIA VERONICA
Provider Other Middle Name:
ROMAN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1366694416
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/04/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1601 WHITEHORSE MERCERVILLE RD
Provider Second Line Business Mailing Address:
COMBS FARM
Provider Business Mailing Address City Name:
TRENTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08619-3836
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-371-0669
Provider Business Mailing Address Fax Number:
609-584-9227

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1601 WHITEHORSE MERCERVILLE RD
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
MERCERVILLE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08619-3836
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-838-9040
Provider Business Practice Location Address Fax Number:
609-838-9042
Provider Enumeration Date:
10/21/2008

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: 207N00000X , with the licence number:  25MA08785500 , 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: 0240478 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com