1891126173 NPI number — MRS. MICHELLE RIVERA DE JESUS APN

Table of content: ERICA LIN M.D. (NPI 1912121500)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891126173 NPI number — MRS. MICHELLE RIVERA DE JESUS APN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DE JESUS
Provider First Name:
MICHELLE
Provider Middle Name:
RIVERA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RIVERA
Provider Other First Name:
MICHELLE
Provider Other Middle Name:
DAJAY
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1891126173
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
140 FRANKLIN TURNPIKE
Provider Second Line Business Mailing Address:
VM6
Provider Business Mailing Address City Name:
WALDWICK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07643
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-447-3603
Provider Business Mailing Address Fax Number:
201-447-5184

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
140 FRANKLIN TURNPIKE
Provider Second Line Business Practice Location Address:
VM6
Provider Business Practice Location Address City Name:
WALDWICK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07643
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-447-3603
Provider Business Practice Location Address Fax Number:
201-447-5184
Provider Enumeration Date:
12/11/2013

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: 364SF0001X , with the licence number:  26NJ00460700 , 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)





Copyright © 2007-2025 www.npivalidator.com