1942420062 NPI number — MS. CAROLE J CHIN NPP

Table of content: MS. MIRIAM JEAN STACEY RN (NPI 1306035761)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942420062 NPI number — MS. CAROLE J CHIN NPP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHIN
Provider First Name:
CAROLE
Provider Middle Name:
J
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
NPP
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:
1942420062
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/24/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
160 HOWELLS RD
Provider Second Line Business Mailing Address:
CAROLE CHIN COUNSELING CENTER
Provider Business Mailing Address City Name:
BAY SHORE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11706-5320
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-647-7198
Provider Business Mailing Address Fax Number:
631-647-7199

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
160 HOWELLS RD
Provider Second Line Business Practice Location Address:
CAROLE CHIN COUNSELING CENTER
Provider Business Practice Location Address City Name:
BAY SHORE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11706-5320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-647-7198
Provider Business Practice Location Address Fax Number:
631-647-7199
Provider Enumeration Date:
04/30/2007

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: 363LP0808X , with the licence number:  F400 1301 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 94V421 . This is a "PTAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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