1942693544 NPI number — MS. LINDA IACOBELLI MS PSYCHOLOGY

Table of content: MS. LINDA IACOBELLI MS PSYCHOLOGY (NPI 1942693544)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942693544 NPI number — MS. LINDA IACOBELLI MS PSYCHOLOGY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
IACOBELLI
Provider First Name:
LINDA
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MS PSYCHOLOGY
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WILEY
Provider Other First Name:
LINDA
Provider Other Middle Name:
IACOBELLI
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1942693544
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
41 EVA AVE
Provider Second Line Business Mailing Address:
STATEN ISLAND
Provider Business Mailing Address City Name:
STATEN ISLAND
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10306-5609
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
646-996-1643
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
41 EVA AVE
Provider Second Line Business Practice Location Address:
STATEN ISLAND
Provider Business Practice Location Address City Name:
STATEN ISLAND
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10306-5609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
646-996-1643
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/06/2015

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: 174400000X , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 252Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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