1447436068 NPI number — MRS. JUSTINE DEUTSCH MYERS LIC. AC.

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 1447436068 NPI number — MRS. JUSTINE DEUTSCH MYERS LIC. AC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MYERS
Provider First Name:
JUSTINE
Provider Middle Name:
DEUTSCH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LIC. AC.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DEUTSCH
Provider Other First Name:
JUSTINE
Provider Other Middle Name:
LINEAL
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
LIC. AC.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1447436068
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/15/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2464 MASSACHUSETTS AVENUE
Provider Second Line Business Mailing Address:
SUITE 420
Provider Business Mailing Address City Name:
CAMBRIDGE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02140
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-499-9993
Provider Business Mailing Address Fax Number:
617-499-9950

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2464 MASSACHUSETTS AVENUE
Provider Second Line Business Practice Location Address:
SUITE 420
Provider Business Practice Location Address City Name:
CAMBRIDGE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-499-9993
Provider Business Practice Location Address Fax Number:
617-499-9950
Provider Enumeration Date:
01/14/2008

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: 171100000X , with the licence number:  233819 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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