1023157849 NPI number — MISS BEVERLEY MARGENA WAITHE MA RD CDE

Table of content: MISS BEVERLEY MARGENA WAITHE MA RD CDE (NPI 1023157849)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023157849 NPI number — MISS BEVERLEY MARGENA WAITHE MA RD CDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WAITHE
Provider First Name:
BEVERLEY
Provider Middle Name:
MARGENA
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
MA RD CDE
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:
1023157849
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
117 ELLIOTT PLACE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SO PLAINFIELD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07080
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-757-8043
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
254 EASTON AVE
Provider Second Line Business Practice Location Address:
DIABETES CARE AND CONTROLL CENTER ST PETERS UNIVERSITY
Provider Business Practice Location Address City Name:
NEW BRUNSWICK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-745-8600
Provider Business Practice Location Address Fax Number:
732-249-0969
Provider Enumeration Date:
02/06/2007

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: 133V00000X , with the licence number:  717562 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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