1477281400 NPI number — MS. KYRA ANN FEDASH-MICHALSKI RPH

Table of content: MS. KYRA ANN FEDASH-MICHALSKI RPH (NPI 1477281400)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477281400 NPI number — MS. KYRA ANN FEDASH-MICHALSKI RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FEDASH-MICHALSKI
Provider First Name:
KYRA
Provider Middle Name:
ANN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RPH
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:
1477281400
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/09/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 MAPLE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST HANOVER
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07936-1553
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-886-7078
Provider Business Mailing Address Fax Number:
973-585-7081

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 BERGEN TPKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIDGEFIELD PARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07660-2390
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-241-6337
Provider Business Practice Location Address Fax Number:
908-241-4034
Provider Enumeration Date:
08/09/2022

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: 183500000X , with the licence number:  28RI01872200 , 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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