1134144314 NPI number — MR. DANIEL WILLIAM BOUCOT CRNA

Table of content: MR. DANIEL WILLIAM BOUCOT CRNA (NPI 1134144314)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134144314 NPI number — MR. DANIEL WILLIAM BOUCOT CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOUCOT
Provider First Name:
DANIEL
Provider Middle Name:
WILLIAM
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
M

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:
1134144314
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
700 US 130 N SUITE 203
Provider Second Line Business Mailing Address:
RANCOCAS ANESTHESIOLOGY, P.A.
Provider Business Mailing Address City Name:
CINNAMINSON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08077
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-829-9345
Provider Business Mailing Address Fax Number:
856-829-3605

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2201 CHAPEL AVE
Provider Second Line Business Practice Location Address:
.KENNEDY HEALTH SYSTEM
Provider Business Practice Location Address City Name:
CHERRY HILL
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-829-9345
Provider Business Practice Location Address Fax Number:
856-829-3605
Provider Enumeration Date:
07/12/2006

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: 367500000X , with the licence number:  26NO10306600 , 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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