1689662165 NPI number — DR. KRISTEN RAINEAR D.O.

Table of content: DR. KRISTEN RAINEAR D.O. (NPI 1689662165)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689662165 NPI number — DR. KRISTEN RAINEAR D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAINEAR
Provider First Name:
KRISTEN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

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:
1689662165
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/23/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1076 E CHESTNUT AVENUE
Provider Second Line Business Mailing Address:
PENN CARDIOLOGY VINELAND
Provider Business Mailing Address City Name:
VINELAND
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08360-5843
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-692-7979
Provider Business Mailing Address Fax Number:
856-794-9479

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1076 E CHESTNUT AVE
Provider Second Line Business Practice Location Address:
PENN CARDIOLOGY VINELAND
Provider Business Practice Location Address City Name:
VINELAND
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08360-5843
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-692-7979
Provider Business Practice Location Address Fax Number:
856-794-9479
Provider Enumeration Date:
10/10/2005

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: 207RC0000X , with the licence number:  MB56674 , 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: 005667400 . This is a "BLACK LUNG" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1539751 . This is a "MINEWORKERS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 959006 . This is a "AMERIHEALTH PPO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 959006 . This is a "KEYSTONE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: J001477 . This is a "CHAMPUS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0403613000 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2K0144 . This is a "HEALTH NET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 4408498 . This is a "AETNA MC" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: MB56674 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 01000308300 . This is a "AMERICHOICE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 83825 . This is a "AMERIGROUP" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 15572241 . This is a "HORIZON" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 5505607 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 580340 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 158725 . This is a "FIRST HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1947845 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P413668 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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