1033453956 NPI number — JASMINE CHARLON APN

Table of content: JASMINE CHARLON APN (NPI 1033453956)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033453956 NPI number — JASMINE CHARLON APN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHARLON
Provider First Name:
JASMINE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APN
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:
1033453956
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/15/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
320 36TH ST
Provider Second Line Business Mailing Address:
APT. 1
Provider Business Mailing Address City Name:
UNION CITY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07087-4710
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-320-0711
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
334 E 25TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10010-3179
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-263-5489
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/15/2012

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: 363LA2200X , with the licence number:  26NJ00403600 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X , with the licence number: F306142-1 , 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: 26NJ00403600 . This is a "NEW JERSEY APN CERTIFICATION NUMBER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: F306142 . This is a "NEW YORK STATE NP LICENSE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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