1821657404 NPI number — MARY JEAN REDMOND ACAGNP

Table of content: MARY JEAN REDMOND ACAGNP (NPI 1821657404)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821657404 NPI number — MARY JEAN REDMOND ACAGNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REDMOND
Provider First Name:
MARY
Provider Middle Name:
JEAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ACAGNP
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:
1821657404
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7 BERWYN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OCEAN VIEW
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08230-1462
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-226-4271
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2500 ENGLISH CREEK AVE
Provider Second Line Business Practice Location Address:
BLDG 400, 2D FL
Provider Business Practice Location Address City Name:
EGG HARBOR TOWNSHIP
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08234-5598
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-677-7777
Provider Business Practice Location Address Fax Number:
609-607-7277
Provider Enumeration Date:
06/07/2019

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: 363L00000X , with the licence number:  26NJ00925500 , 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)