1447247689 NPI number — BRIAN L SHAFFER MD

Table of content: BRIAN L SHAFFER MD (NPI 1447247689)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447247689 NPI number — BRIAN L SHAFFER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHAFFER
Provider First Name:
BRIAN
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1447247689
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
133 FRANKLIN CORNER RD
Provider Second Line Business Mailing Address:
2ND FL
Provider Business Mailing Address City Name:
LAWRENCEVILLE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08648-2531
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-436-5900
Provider Business Mailing Address Fax Number:
609-452-0222

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
133 FRANKLIN CORNER RD
Provider Second Line Business Practice Location Address:
2ND FL
Provider Business Practice Location Address City Name:
LAWRENCEVILLE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08648-2531
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-436-5900
Provider Business Practice Location Address Fax Number:
609-452-0222
Provider Enumeration Date:
10/03/2005

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: 207R00000X , with the licence number:  25MA05504600 , 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)