1962467480 NPI number — MRS. JENNIFER MARIE PASSINO MSPT

Table of content: (NPI 1467477950)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962467480 NPI number — MRS. JENNIFER MARIE PASSINO MSPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PASSINO
Provider First Name:
JENNIFER
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KNIGHT
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS PT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1962467480
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/05/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12552 SWEET LEAF TERRACE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRFAX
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22033-2462
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-385-3910
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10525 WEST DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRFAX
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22030-4230
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-934-9411
Provider Business Practice Location Address Fax Number:
703-934-9497
Provider Enumeration Date:
04/18/2006

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: 225100000X , with the licence number:  2305203253 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: G02052 . This is a "MEDICARE GROUP PIN" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".




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