1609225218 NPI number — KAREN S. LARSEN MA

Table of content: KAREN S. LARSEN MA (NPI 1609225218)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609225218 NPI number — KAREN S. LARSEN MA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LARSEN
Provider First Name:
KAREN
Provider Middle Name:
S.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA
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:
1609225218
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/06/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 N BRIDGE ST
Provider Second Line Business Mailing Address:
500 NORTH BRIDGE STREET
Provider Business Mailing Address City Name:
BRIDGEWATER
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08807-2135
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-725-2800
Provider Business Mailing Address Fax Number:
908-704-1790

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 BRIDGE STREET
Provider Second Line Business Practice Location Address:
500 BRIDGE STREET
Provider Business Practice Location Address City Name:
BRIDGEWATER
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-725-2800
Provider Business Practice Location Address Fax Number:
908-704-1790
Provider Enumeration Date:
06/06/2016

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: 101YM0800X , 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: 0023701 . This is a "AGENCY MEDICAID" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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