1164612685 NPI number — MRS. ANNETTE MARIE JUSKIEWICZ PT

Table of content: MRS. ANNETTE MARIE JUSKIEWICZ PT (NPI 1164612685)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164612685 NPI number — MRS. ANNETTE MARIE JUSKIEWICZ PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JUSKIEWICZ
Provider First Name:
ANNETTE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PORCH
Provider Other First Name:
ANNETTE
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1164612685
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/31/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18 NEWARK POMPTON TURNPIKE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIVERDALE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07457
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-616-4555
Provider Business Mailing Address Fax Number:
973-616-3430

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18 NEWARK POMPTON TURNPIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIVERDALE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07457
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-616-4555
Provider Business Practice Location Address Fax Number:
973-616-3430
Provider Enumeration Date:
07/31/2007

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: 2251P0200X , with the licence number:  40QA00531300 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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