1699932897 NPI number — V. MARGARET NEWMAN THERAPEUTIC SERVICE, LLC

Table of content: (NPI 1699932897)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699932897 NPI number — V. MARGARET NEWMAN THERAPEUTIC SERVICE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
V. MARGARET NEWMAN THERAPEUTIC SERVICE, LLC
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:
1699932897
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/26/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
215 HIGHLAND AVE
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
HADDON TOWNSHIP
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08108-2634
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-952-2688
Provider Business Mailing Address Fax Number:
856-488-6222

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
215 HIGHLAND AVE
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
HADDON TOWNSHIP
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08108-2634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-952-2688
Provider Business Practice Location Address Fax Number:
856-488-6222
Provider Enumeration Date:
05/16/2008

Additional Information

Authorized Official

Authorized Official Last Name:
NEWMAN-FREEMAN
Authorized Official First Name:
VALERIE
Authorized Official Middle Name:
MARGARET
Authorized Official Title or Position:
EXECUTIVE OFFICER
Authorized Official Telephone Number:
856-952-2688

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  44SC05240200 , 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: 128519Y5J . This is a "MEDICARE PTAN (INDIVIDUAL)" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0043192 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 798708 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 807459000 . This is a "MAGELLAN HEALTH SERVICES" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 128520 . This is a "MEDICARE PTAN (GROUP)" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2623548000 . This is a "BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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