1467770990 NPI number — MS. ELIZABETH PUGH MYLER APN, IBCLC

Table of content: MS. ELIZABETH PUGH MYLER APN, IBCLC (NPI 1467770990)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467770990 NPI number — MS. ELIZABETH PUGH MYLER APN, IBCLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MYLER
Provider First Name:
ELIZABETH
Provider Middle Name:
PUGH
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
APN, IBCLC
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:
1467770990
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/02/2018
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:
254B MOUNTAIN AVE STE 304
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HACKETTSTOWN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07840-2413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-852-6400
Provider Business Practice Location Address Fax Number:
908-852-6450
Provider Enumeration Date:
05/07/2010

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: 163WL0100X , with the licence number:  26NR12051400 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 26NJ00738500 , 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)





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