1821012055 NPI number — ANNA FEDERICO FNP

Table of content: ANNA FEDERICO FNP (NPI 1821012055)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821012055 NPI number — ANNA FEDERICO FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FEDERICO
Provider First Name:
ANNA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP
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:
1821012055
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/22/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
380 LAKESIDE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HEWITT
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07421-2905
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-389-2727
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
156 NEWARK POMPTON TPKE
Provider Second Line Business Practice Location Address:
MINUTECLINIC INSIDE CVS
Provider Business Practice Location Address City Name:
PEQUANNOCK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07440-1327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-389-2727
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/27/2006

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: 363LF0000X , with the licence number:  26NN07559800 , 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)