1417341900 NPI number — MRS. EVANGELIA JOSEPHINE CUSH BSW

Table of content: MRS. EVANGELIA JOSEPHINE CUSH BSW (NPI 1417341900)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417341900 NPI number — MRS. EVANGELIA JOSEPHINE CUSH BSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CUSH
Provider First Name:
EVANGELIA
Provider Middle Name:
JOSEPHINE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
BSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CUSH
Provider Other First Name:
EVANGELIA
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RBT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1417341900
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/27/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 PIERPONT PLACE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STATEN ISLAND
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10314
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
347-733-9393
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 CORPORATE CENTER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANALAPAN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07726-8736
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-417-8669
Provider Business Practice Location Address Fax Number:
844-444-0964
Provider Enumeration Date:
03/24/2015

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: 106S00000X , with the licence number:  RBT-23-293389 , 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)





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