1093892507 NPI number — JACQUELINE BURNS NP

Table of content: JACQUELINE BURNS NP (NPI 1093892507)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093892507 NPI number — JACQUELINE BURNS NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURNS
Provider First Name:
JACQUELINE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
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:
1093892507
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:
2 TREETOP LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTAMPTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08060-4403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-702-8595
Provider Business Mailing Address Fax Number:
609-261-7199

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3111 ROUTE 38 STE 11
Provider Second Line Business Practice Location Address:
PMB 120
Provider Business Practice Location Address City Name:
MOUNT LAUREL
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08054-9762
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-261-5755
Provider Business Practice Location Address Fax Number:
609-261-7199
Provider Enumeration Date:
11/01/2006

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: 363LA2200X , with the licence number:  26NN08660000 , 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: 2240115000 . This is a "AMERIHEALTH/KEYSTONE/PC" identifier . This identifiers is of the category "OTHER".




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