1992787253 NPI number — MRS. CAROL L MANSFIELD OTR CHT

Table of content: MRS. CAROL L MANSFIELD OTR CHT (NPI 1992787253)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992787253 NPI number — MRS. CAROL L MANSFIELD OTR CHT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MANSFIELD
Provider First Name:
CAROL
Provider Middle Name:
L
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OTR CHT
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:
1992787253
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/29/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1259 ROUTE 46
Provider Second Line Business Mailing Address:
BUILDING #3
Provider Business Mailing Address City Name:
PARSIPPANY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07054-4909
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-334-4321
Provider Business Mailing Address Fax Number:
973-334-1095

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2333 MORRIS AVE STE B105
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNION
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07083-5714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-686-8766
Provider Business Practice Location Address Fax Number:
908-686-8676
Provider Enumeration Date:
11/14/2005

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: 225XH1200X , with the licence number:  46TR00073300 , 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)





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