1134555410 NPI number — MISS COLLEEN PATRICIA DAUER LSW

Table of content: MISS COLLEEN PATRICIA DAUER LSW (NPI 1134555410)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134555410 NPI number — MISS COLLEEN PATRICIA DAUER LSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAUER
Provider First Name:
COLLEEN
Provider Middle Name:
PATRICIA
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
LSW
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:
1134555410
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15 BIRCHWOOD LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RAMSEY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07446-2102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-327-9247
Provider Business Mailing Address Fax Number:
201-327-9247

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 BIRCHWOOD LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RAMSEY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07446-2102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-327-9247
Provider Business Practice Location Address Fax Number:
201-327-9247
Provider Enumeration Date:
09/19/2013

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: 104100000X , with the licence number:  44SL05591900 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041S0200X , with the licence number: 44SL05591900 , 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: 0 . This is a "N/A" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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