1528422482 NPI number — KATRINA MEILING GOULD DO

Table of content: KATRINA MEILING GOULD DO (NPI 1528422482)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528422482 NPI number — KATRINA MEILING GOULD DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOULD
Provider First Name:
KATRINA
Provider Middle Name:
MEILING
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:
SHUM
Provider Other First Name:
KATRINA
Provider Other Middle Name:
MEILING
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1528422482
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/26/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2330 ROUTE 33 STE 107
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROBBINSVILLE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08691-1431
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-303-4401
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2330 ROUTE 33 STE 107
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROBBINSVILLE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08691-1431
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-303-4400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/07/2016

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: 207Q00000X , with the licence number:  25MB10580500 , 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)