1396728606 NPI number — DR. ELIZABETH ANN RECUPERO D.O.

Table of content: DR. ELIZABETH ANN RECUPERO D.O. (NPI 1396728606)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396728606 NPI number — DR. ELIZABETH ANN RECUPERO D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RECUPERO
Provider First Name:
ELIZABETH
Provider Middle Name:
ANN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
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:
1396728606
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/14/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
103 CONCORDE PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANDEVILLE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70471-1854
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-648-1247
Provider Business Mailing Address Fax Number:
888-354-0043

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
103 CONCORDE PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANDEVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70471-1854
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-648-1247
Provider Business Practice Location Address Fax Number:
888-354-0043
Provider Enumeration Date:
11/22/2005

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: 207R00000X , with the licence number:  311932 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: MB67859 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3110885 . This is a "AETNA HMO PEDIATRICS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: RE1437759 . This is a "PA BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: F06020 . This is a "PHS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2996178 . This is a "AETNA HMO (ADULTS)" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 4685447 . This is a "AETNA TRADITIONAL" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2144789001 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 7685447 . This is a "AETNA TRADITIONAL ADULTS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P2216217 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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