1043949514 NPI number — MS. COLLEEN KJEMS LCADC, CCS, NCAC1, I

Table of content: MS. COLLEEN KJEMS LCADC, CCS, NCAC1, I (NPI 1043949514)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043949514 NPI number — MS. COLLEEN KJEMS LCADC, CCS, NCAC1, I

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KJEMS
Provider First Name:
COLLEEN
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCADC, CCS, NCAC1, I
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KJEMS
Provider Other First Name:
COLLEEN
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCADC, CCS, NCAC1, I
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1043949514
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
28 FOX ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHITING
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08759-3612
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
848-469-0531
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
615 HOPE RD STE 5B5A&4A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EATONTOWN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07724-1277
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-858-5432
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/08/2022

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: 101YA0400X , with the licence number:  37LC00090000 , 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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