1568594026 NPI number — ADVANCE THRU PSYCHOTHERAPY & FAMILY DEVELOPMENT, PA

Table of content: (NPI 1568594026)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568594026 NPI number — ADVANCE THRU PSYCHOTHERAPY & FAMILY DEVELOPMENT, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCE THRU PSYCHOTHERAPY & FAMILY DEVELOPMENT, PA
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:
1568594026
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2737 PRINCETON PIKE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAWRENCEVILLE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08648-3220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-883-2577
Provider Business Mailing Address Fax Number:
609-883-2092

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2737 PRINCETON PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAWRENCEVILLE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08648-3220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-883-2577
Provider Business Practice Location Address Fax Number:
609-883-2092
Provider Enumeration Date:
03/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SOFAIR-FISCH
Authorized Official First Name:
TAMARA
Authorized Official Middle Name:
Authorized Official Title or Position:
PSYCHOLOGIST
Authorized Official Telephone Number:
609-883-2577

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  35S100165100 , 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)

  • Identifier: 16146 . This is a "CIGNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P402017 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 051524 . This is a "VALUE OPTIONS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 41024000 . This is a "MAGELLAN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: AETNA . This is a "3497258" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: V5704 . This is a "EMPIRE BLUE CROSS SHIELD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0504980000 . This is a "AMERIHEALTH INDEPENDENCE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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