1225334246 NPI number — MS. MARA KRAMER VAN ETTEN MS, CGC

Table of content: MS. MARA KRAMER VAN ETTEN MS, CGC (NPI 1225334246)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225334246 NPI number — MS. MARA KRAMER VAN ETTEN MS, CGC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VAN ETTEN
Provider First Name:
MARA
Provider Middle Name:
KRAMER
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MS, CGC
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:
1225334246
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/09/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4 EATON ROW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCOTCH PLAINS
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07076-2835
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-591-9054
Provider Business Mailing Address Fax Number:
908-757-3919

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 E 77TH ST
Provider Second Line Business Practice Location Address:
SECOND FLOOR
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10075-1851
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-434-2160
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/09/2011

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: 170300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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