1720278955 NPI number — KAREN MEHEGAN DPT

Table of content: KAREN MEHEGAN DPT (NPI 1720278955)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720278955 NPI number — KAREN MEHEGAN DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEHEGAN
Provider First Name:
KAREN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LUGRIS
Provider Other First Name:
KAREN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1720278955
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11 EAGLE ROCK AVE
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
EAST HANOVER
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07936-3167
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-887-9000
Provider Business Mailing Address Fax Number:
973-887-3816

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1265 PATERSON PLANK RD
Provider Second Line Business Practice Location Address:
SUITE 2C
Provider Business Practice Location Address City Name:
SECAUCUS
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07094-3242
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-583-6900
Provider Business Practice Location Address Fax Number:
201-583-6901
Provider Enumeration Date:
07/25/2007

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:  40QA01069800 , 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: P00960380 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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