1215911987 NPI number — DYANNE WESTERBERG DO

Table of content: DYANNE WESTERBERG DO (NPI 1215911987)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215911987 NPI number — DYANNE WESTERBERG DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WESTERBERG
Provider First Name:
DYANNE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215911987
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/20/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3 COOPER PLZ
Provider Second Line Business Mailing Address:
SUITE 502
Provider Business Mailing Address City Name:
CAMDEN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08103-1438
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-342-2921
Provider Business Mailing Address Fax Number:
856-968-8499

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3156 RIVER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMDEN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08105-4242
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-963-0126
Provider Business Practice Location Address Fax Number:
856-365-0279
Provider Enumeration Date:
12/05/2005

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: 207Q00000X , with the licence number:  25MB08313300 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X , with the licence number: OS005360L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 3423581000 . This is a "AMERIHEATLH, KEYSTONE, IBC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 051957 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1667305 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1667307 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010046053 . This is a "AMERICHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1667308 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1667304 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".




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