1255456927 NPI number — DARLENE M OSIPUK MD

Table of content: DARLENE M OSIPUK MD (NPI 1255456927)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255456927 NPI number — DARLENE M OSIPUK MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OSIPUK
Provider First Name:
DARLENE
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1255456927
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:
420 BOULEVARD
Provider Second Line Business Mailing Address:
SUITE 106
Provider Business Mailing Address City Name:
MOUNTAIN LAKES
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07046-1742
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-263-8282
Provider Business Mailing Address Fax Number:
973-263-3141

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
420 BOULEVARD
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
MOUNTAIN LAKES
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07046-1742
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-263-8282
Provider Business Practice Location Address Fax Number:
973-263-3141
Provider Enumeration Date:
03/20/2007

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: 2084P0800X , with the licence number:  25MA03999900 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084P0800X , with the licence number: 148729-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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