1356098149 NPI number — TANESHA ROBINSON

Table of content: TANESHA ROBINSON (NPI 1356098149)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356098149 NPI number — TANESHA ROBINSON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBINSON
Provider First Name:
TANESHA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1356098149
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/02/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1503 SAINT GEORGES AVE STE 106
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLONIA
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07067-3427
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-388-1716
Provider Business Mailing Address Fax Number:
856-212-1214

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1503 SAINT GEORGES AVE STE 106
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLONIA
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07067-3427
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-388-1716
Provider Business Practice Location Address Fax Number:
856-212-1214
Provider Enumeration Date:
03/02/2022

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: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 37LC00260400 . This is a "STATE LICENSE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".