1760484018 NPI number — CHRISTINE EDITH KERSHNER HORAH D.O.

Table of content: CHRISTINE EDITH KERSHNER HORAH D.O. (NPI 1760484018)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760484018 NPI number — CHRISTINE EDITH KERSHNER HORAH D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HORAH
Provider First Name:
CHRISTINE
Provider Middle Name:
EDITH KERSHNER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
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:
1760484018
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
412 SUBURBAN PLZ
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWARK
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19711-3564
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-738-3770
Provider Business Mailing Address Fax Number:
302-738-4749

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
412 SUBURBAN PLZ
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19711-3564
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-738-3770
Provider Business Practice Location Address Fax Number:
302-738-4749
Provider Enumeration Date:
06/01/2005

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: 207Q00000X , with the licence number:  C20005526 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X , with the licence number: H0054380 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 510410752 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00908838 . This is a "MEDICARE RAILROAD PROVIDER PTAN" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 510410752 . This is a "EMPLOYER IDENT. NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0001132004 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".




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