1225107600 NPI number — DR. ANNA MARIA MARTUSCIELLO D.C.

Table of content: DR. ANNA MARIA MARTUSCIELLO D.C. (NPI 1225107600)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225107600 NPI number — DR. ANNA MARIA MARTUSCIELLO D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTUSCIELLO
Provider First Name:
ANNA MARIA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
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:
1225107600
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7702 S CASS
Provider Second Line Business Mailing Address:
STE 220
Provider Business Mailing Address City Name:
DARIEN
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60561
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-493-9399
Provider Business Mailing Address Fax Number:
630-493-0950

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7702 S CASS AVE
Provider Second Line Business Practice Location Address:
STE220
Provider Business Practice Location Address City Name:
DARIEN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60561-5093
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-493-9399
Provider Business Practice Location Address Fax Number:
630-493-0950
Provider Enumeration Date:
11/07/2006

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: 111N00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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