1194766097 NPI number — MRS. MONIKA ADAM DESOUSA MPT

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194766097 NPI number — MRS. MONIKA ADAM DESOUSA MPT

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

DESOUSA

Provider First Name:

MONIKA

Provider Middle Name:

ADAM

Provider Name Prefix Text:

MRS.

Provider Name Suffix Text:

Provider Credential Text:

MPT

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

MUNJAPARA

Provider Other First Name:

MONIKA

Provider Other Middle Name:

JAYANTI

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

MPT

Provider Other Last Name Type Code:

1

NPI Number:

1194766097

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

01/09/2008

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

2775 SCHOENERSVILLE RD

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

BETHLEHEM

Provider Business Mailing Address State Name:

PA

Provider Business Mailing Address Postal Code:

18017-7307

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

610-861-8080

Provider Business Mailing Address Fax Number:

610-807-0366

Provider First Line Business Practice Location Address:

2775 SCHOENERSVILLE RD

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

BETHLEHEM

Provider Business Practice Location Address State Name:

PA

Provider Business Practice Location Address Postal Code:

18017-7307

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

610-861-8080

Provider Business Practice Location Address Fax Number:

610-807-0366

Provider Enumeration Date:

06/10/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 225100000X , with the licence number:  PT017566 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 225100000X , with the licence number: 40QA01182500 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 0090212000 . This is a "INDEPENDENCE BLUE CROSS" identifier . This identifiers is of the category "OTHER".
• Identifier: 0090212000 . This is a "AMERIHEALTH" identifier . This identifiers is of the category "OTHER".
• Identifier: 180537 . This is a "HIGHMARK BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
• Identifier: 2201264 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 0122144 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
• Identifier: 01344201 . This is a "CAPITAL BLUE CROSS" identifier . This identifiers is of the category "OTHER".
• Identifier: 821695 . This is a "FIRST PRIORITY HEALTH" identifier . This identifiers is of the category "OTHER".
• Identifier: 329121 . This is a "HEALTHAMERICA/HEALTHASSUR" identifier . This identifiers is of the category "OTHER".
• Identifier: 0090212000 . This is a "KEYSTONE HEALTH EAST" identifier . This identifiers is of the category "OTHER".
• Identifier: 01344201 . This is a "KEYSTONE HEALTH CENTRAL" identifier . This identifiers is of the category "OTHER".
• Identifier: 1808084 . This is a "CIGNA HEALTHCARE" identifier . This identifiers is of the category "OTHER".
• Identifier: P864427 . This is a "OXFORD HEALTH PLANS" identifier . This identifiers is of the category "OTHER".