1700828217 NPI number — JENNIFER S HILLIARD PT

Table of content: JENNIFER S HILLIARD PT (NPI 1700828217)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700828217 NPI number — JENNIFER S HILLIARD PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HILLIARD
Provider First Name:
JENNIFER
Provider Middle Name:
S
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:
ROBINSON
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
S
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1700828217
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
790 REMINGTON BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOLINGBROOK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60440-4909
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1030 FORREST AVE STE 105A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOVER
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19904-3310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-268-8880
Provider Business Practice Location Address Fax Number:
302-278-0272
Provider Enumeration Date:
06/11/2006

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:  J10000997 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2286952000 . This is a "IBC AMERIHEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1000037834 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 76912207 . This is a "CAREFIRST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1609259 . This is a "PABS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 363854 . This is a "MAMSI PROVIDER NUMBER" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 5070-0044 . This is a "CAREFIRST" identifier . This identifiers is of the category "OTHER".




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