1871068916 NPI number — JEFFRIE POPPLEWELL LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871068916 NPI number — JEFFRIE POPPLEWELL LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEFFRIE POPPLEWELL LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CHRISTIAN COUNSELING ASSOCIATION
Provider Other Organization Name Type Code:
3
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:
1871068916
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/09/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 GORGE RD APT 72
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLIFFSIDE PARK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07010-2770
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-957-3497
Provider Business Mailing Address Fax Number:
201-886-9531

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
245 STANTON MT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEBANON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08833-3106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-957-3497
Provider Business Practice Location Address Fax Number:
201-886-9531
Provider Enumeration Date:
10/04/2018

Additional Information

Authorized Official

Authorized Official Last Name:
POPPLEWELL
Authorized Official First Name:
JEFFRIE
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS OWNER
Authorized Official Telephone Number:
201-957-3497

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP1600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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