1053319921 NPI number — MRS. CHRISTINE DIANE MEASE MPT

Table of content: KRISTEN LEIGH MINARD FNP-C (NPI 1023568342)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053319921 NPI number — MRS. CHRISTINE DIANE MEASE MPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEASE
Provider First Name:
CHRISTINE
Provider Middle Name:
DIANE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MPT
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:
1053319921
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
209 CARLTON CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
THOROFARE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08086-2017
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
132 GROVE ST
Provider Second Line Business Practice Location Address:
COOPER PHYSICAL THERAPY
Provider Business Practice Location Address City Name:
HADDONFIELD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08033-1224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-795-9330
Provider Business Practice Location Address Fax Number:
856-854-7935
Provider Enumeration Date:
07/13/2005

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: 225100000X , with the licence number:  QA007131 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225100000X , with the licence number: PT009660L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 22-21170196 . This is a "NJ CARPENTERS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2356297000 . This is a "AMERIHEALTH HMO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P3314980 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 22-2170196 . This is a "INTERGROUP" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 22-2170196 . This is a "DEVON" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1682858 . This is a "AMERIHEALTH PPO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1682858 . This is a "PA BLUE SHIELD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 22-2170196 . This is a "SIMCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 22-2170196 . This is a "HORIZON BSNJ" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 22-2170196 . This is a "FIRST HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 222107019643 . This is a "TRICARE/CHAMPUS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 222170196041 . This is a "TRICARE/CHAMPUS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 22-2170196 . This is a "LOCAL 825" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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