1134607518 NPI number — MS. ROBIN BAILEY MASTER'S OF HUMAN SE

Table of content: MS. ROBIN BAILEY MASTER'S OF HUMAN SE (NPI 1134607518)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134607518 NPI number — MS. ROBIN BAILEY MASTER'S OF HUMAN SE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAILEY
Provider First Name:
ROBIN
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MASTER'S OF HUMAN SE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BAILEY
Provider Other First Name:
ROBIN
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1134607518
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/30/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21 LACKAWANNA PL APT 552
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLOOMFIELD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07003-2961
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-885-3381
Provider Business Mailing Address Fax Number:
973-372-0162

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
531-533 SOUTH ORANGE AVENUE
Provider Second Line Business Practice Location Address:
2ND. FL.
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07103-0700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-885-3381
Provider Business Practice Location Address Fax Number:
973-885-3381
Provider Enumeration Date:
07/30/2018

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: 374U00000X , with the licence number:  HP0217200 , 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: 452-84-1553 . This is a "PRIVATE PAY" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com