1114935152 NPI number — SUSAN E MATARESE PA C

Table of content: SUSAN E MATARESE PA C (NPI 1114935152)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114935152 NPI number — SUSAN E MATARESE PA C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MATARESE
Provider First Name:
SUSAN
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA C
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:
1114935152
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 WINTERCORN CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOCKESSIN
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19707-1402
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-239-9372
Provider Business Mailing Address Fax Number:
302-239-9342

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 PEOPLES PLZ
Provider Second Line Business Practice Location Address:
SUITE 1285
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19702-5701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-832-0880
Provider Business Practice Location Address Fax Number:
302-832-1640
Provider Enumeration Date:
08/04/2006

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: 363AM0700X , with the licence number:  C5-0000315 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363AM0700X , with the licence number: MA002115L , 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)





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