1225570708 NPI number — NEWTON-ATLANTIC, LLC

Table of content: (NPI 1225570708)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225570708 NPI number — NEWTON-ATLANTIC, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEWTON-ATLANTIC, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1225570708
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/15/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2133 UPTON DR
Provider Second Line Business Mailing Address:
STE., 126-182
Provider Business Mailing Address City Name:
VIRGINIA BEACH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23454-1193
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-355-5080
Provider Business Mailing Address Fax Number:
757-355-5081

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1520 STONEMOSS CT
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
VIRGINIA BEACH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23462-5731
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-388-5080
Provider Business Practice Location Address Fax Number:
757-355-5081
Provider Enumeration Date:
11/15/2016

Additional Information

Authorized Official

Authorized Official Last Name:
BAPTISTE ZWAHL
Authorized Official First Name:
SHIRLEY
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER/ADMINISTRATOR
Authorized Official Telephone Number:
757-355-5080

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0240780434 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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