1467465203 NPI number — KERI LYNN INGRASSIA-SQUIERS DO

Table of content: KERI LYNN INGRASSIA-SQUIERS DO (NPI 1467465203)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467465203 NPI number — KERI LYNN INGRASSIA-SQUIERS DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
INGRASSIA-SQUIERS
Provider First Name:
KERI
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
INGRASSIA
Provider Other First Name:
KERI
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DO
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1467465203
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/12/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 95000 LB# 7550
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19195-7550
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
844-362-1735
Provider Business Mailing Address Fax Number:
973-290-7495

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HASTINGS SQUARE PLAZA #5
Provider Second Line Business Practice Location Address:
SCHOOLEYS MOUNTAIN ROAD
Provider Business Practice Location Address City Name:
HACKETTSTOWN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07840
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-979-0050
Provider Business Practice Location Address Fax Number:
908-979-0044
Provider Enumeration Date:
08/14/2006

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: 207R00000X , with the licence number:  MB72580 , 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)





Copyright © 2007-2025 www.npivalidator.com