1609020627 NPI number — BETH SHARON LALIBERTE PT

Table of content: BETH SHARON LALIBERTE PT (NPI 1609020627)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609020627 NPI number — BETH SHARON LALIBERTE PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LALIBERTE
Provider First Name:
BETH
Provider Middle Name:
SHARON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SAVITZ
Provider Other First Name:
BETH
Provider Other Middle Name:
SHARON
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1609020627
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2222 SULLIVAN TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EASTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18040-7958
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-944-9782
Provider Business Mailing Address Fax Number:
610-438-2024

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
70 STOCKTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OCEAN GROVE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07756-1150
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-774-1316
Provider Business Practice Location Address Fax Number:
732-776-6313
Provider Enumeration Date:
11/05/2008

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: 225100000X , with the licence number:  40QA00303600 , 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)