1700187317 NPI number — CHANEL LAUREN PORCHIA-ALBERT CD,CLC

Table of content: CHANEL LAUREN PORCHIA-ALBERT CD,CLC (NPI 1700187317)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700187317 NPI number — CHANEL LAUREN PORCHIA-ALBERT CD,CLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PORCHIA-ALBERT
Provider First Name:
CHANEL
Provider Middle Name:
LAUREN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CD,CLC
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:
1700187317
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50 CHURCH ST STE 105
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTCLAIR
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07042-2761
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
347-778-3490
Provider Business Mailing Address Fax Number:
347-787-4534

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
743 HANCOCK ST
Provider Second Line Business Practice Location Address:
SECOND FLOOR
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11233-1204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-512-8155
Provider Business Practice Location Address Fax Number:
347-787-4534
Provider Enumeration Date:
11/12/2010

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: 374J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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