1407245889 NPI number — SAMANTHA JAYNE MCKINSTRY MSN, FNP

Table of content: SAMANTHA JAYNE MCKINSTRY MSN, FNP (NPI 1407245889)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407245889 NPI number — SAMANTHA JAYNE MCKINSTRY MSN, FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCKINSTRY
Provider First Name:
SAMANTHA
Provider Middle Name:
JAYNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSN, FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RODGERS
Provider Other First Name:
SAMANTHA
Provider Other Middle Name:
JAYNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSN, FNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1407245889
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/10/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 PROSPECT AVE
Provider Second Line Business Mailing Address:
THE ORTHOPAEDIC INSTITUTE
Provider Business Mailing Address City Name:
HACKENSACK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07601-1914
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
551-996-2000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 PROSPECT AVE
Provider Second Line Business Practice Location Address:
THE ORTHOPAEDIC INSTITUTE
Provider Business Practice Location Address City Name:
HACKENSACK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07601-1914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
551-996-2000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/22/2015

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: 363LF0000X , with the licence number:  26NJ00549000 , 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)