1538411830 NPI number — RUSTICA ATIENZA APN

Table of content: RUSTICA ATIENZA APN (NPI 1538411830)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538411830 NPI number — RUSTICA ATIENZA APN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ATIENZA
Provider First Name:
RUSTICA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APN
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:
1538411830
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5730 EXECUTIVE DR STE 230
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CATONSVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21228-1762
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-831-3540
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 CEDAR CREST VILLAGE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POMPTON PLAINS
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07444-2100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-831-3540
Provider Business Practice Location Address Fax Number:
973-831-3503
Provider Enumeration Date:
10/10/2012

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: 363L00000X , with the licence number:  26NJ00383800 , 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)