1194167577 NPI number — JILLIAN DIIONNO PA-C

Table of content: JILLIAN DIIONNO PA-C (NPI 1194167577)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194167577 NPI number — JILLIAN DIIONNO PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIIONNO
Provider First Name:
JILLIAN
Provider Middle Name:
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:
MERRELL
Provider Other First Name:
JILLIAN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1194167577
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
57 ROUTE 46 STE 107
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HACKETTSTOWN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07840-2695
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-813-9700
Provider Business Mailing Address Fax Number:
908-813-2861

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
57 ROUTE 46 STE 107
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HACKETTSTOWN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07840-2695
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-813-9700
Provider Business Practice Location Address Fax Number:
908-813-2861
Provider Enumeration Date:
07/25/2013

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: 363A00000X , with the licence number:  25MP00312100 , 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)