1386200541 NPI number — MISS GABRIELLE NANCY MERANSHIAN

Table of content: MISS GABRIELLE NANCY MERANSHIAN (NPI 1386200541)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386200541 NPI number — MISS GABRIELLE NANCY MERANSHIAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MERANSHIAN
Provider First Name:
GABRIELLE
Provider Middle Name:
NANCY
Provider Name Prefix Text:
MISS
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:
1386200541
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/14/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
529 SUNHAVEN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLAYTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08312-1935
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-725-2260
Provider Business Mailing Address Fax Number:
856-728-7459

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
529 SUNHAVEN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLAYTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08312-1935
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-725-2260
Provider Business Practice Location Address Fax Number:
856-728-7459
Provider Enumeration Date:
05/14/2019

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: 133V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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