1477510642 NPI number — CREATIVE REMINISCENCE & PSYCHOTHERAPY, PC

Table of content: NAHID NIKKI ESANI M.D. (NPI 1902023989)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477510642 NPI number — CREATIVE REMINISCENCE & PSYCHOTHERAPY, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CREATIVE REMINISCENCE & PSYCHOTHERAPY, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1477510642
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/06/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
41 GERALDINE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST WINDSOR
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08520-2631
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-443-3828
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALLENTOWN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08501-1615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-443-3828
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TAHIR
Authorized Official First Name:
LAURA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
609-443-3828

Provider Taxonomy Codes

  • Taxonomy code: 305S00000X , with the licence number:  35SI00306500 , 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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