1215126230 NPI number — MRS. KRISTA KELEIGH GLEASON M.A., LAC

Table of content: MRS. KRISTA KELEIGH GLEASON M.A., LAC (NPI 1215126230)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215126230 NPI number — MRS. KRISTA KELEIGH GLEASON M.A., LAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GLEASON
Provider First Name:
KRISTA
Provider Middle Name:
KELEIGH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.A., LAC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KELEIGH
Provider Other First Name:
KRISTA
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.A
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1215126230
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
309 ROUTE 35
Provider Second Line Business Mailing Address:
APT. 2H
Provider Business Mailing Address City Name:
POINT PLEASANT
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08742
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-664-3725
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
160 ROUTE 9
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAYVILLE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08721
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-349-5550
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/16/2007

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: 101YM0800X , with the licence number:  37AC00049200 , 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)





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