1083733158 NPI number — DR. JAYNE SCHACHTER WALCO PH.D.

Table of content: DR. JAYNE SCHACHTER WALCO PH.D. (NPI 1083733158)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083733158 NPI number — DR. JAYNE SCHACHTER WALCO PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALCO
Provider First Name:
JAYNE
Provider Middle Name:
SCHACHTER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SCHACHTER
Provider Other First Name:
JAYNE
Provider Other Middle Name:
ELLEN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PH.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1083733158
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:
420 BOULEVARD
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
MOUNTAIN LAKES
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07046-1742
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-334-8383
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
420 BOULEVARD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
MOUNTAIN LAKES
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07046-1742
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-334-8383
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/28/2007

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: 103T00000X , with the licence number:  3194 , 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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