1073529913 NPI number — DR. SANDRA LEE RAY D.C.

Table of content: DR. SANDRA LEE RAY D.C. (NPI 1073529913)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073529913 NPI number — DR. SANDRA LEE RAY D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAY
Provider First Name:
SANDRA
Provider Middle Name:
LEE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FARNELLI
Provider Other First Name:
SANDRA
Provider Other Middle Name:
LEE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1073529913
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/18/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
507 WILLIAMSTOWN NEW FREEDOM RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SICKLERVILLE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08081-1775
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-629-1199
Provider Business Mailing Address Fax Number:
856-629-3909

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
507 WILLIAMSTOWN NEW FREEDOM RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SICKLERVILLE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08081-1775
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-629-1199
Provider Business Practice Location Address Fax Number:
856-629-3909
Provider Enumeration Date:
07/31/2006

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: 111N00000X , with the licence number:  38MC00304500 , 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)

  • Identifier: 2412136000 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 9729440 . This is a "CIGNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 001746768 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: K55589 . This is a "HORIZON BLUE CROSS BLUE SHIELD NEW JERSEY" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 192487 . This is a "CHN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 001746768 . This is a "PERSONAL CHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 222825665 . This is a "AMERICAN HEALTH SPECIALIT" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 222825665 . This is a "ALANTICARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2412136000 . This is a "KEYSTONE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3365392 . This is a "AETNA HEALTH INS." identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: K55589 . This is a "HORIZON BC BS PLUS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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