1538379771 NPI number — MS. HEATHER ELIZABETH FEAN APN

Table of content: MS. HEATHER ELIZABETH FEAN APN (NPI 1538379771)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538379771 NPI number — MS. HEATHER ELIZABETH FEAN APN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FEAN
Provider First Name:
HEATHER
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
APN
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:
1538379771
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/28/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
402 LIPPINCOTT DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARLTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08053-4112
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-782-3300
Provider Business Mailing Address Fax Number:
856-504-8029

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
181 W WHITE HORSE PIKE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
BERLIN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08009-2032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-767-6670
Provider Business Practice Location Address Fax Number:
856-767-3518
Provider Enumeration Date:
05/23/2007

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: 363LA2200X , with the licence number:  26NJ00087500 , 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: 077356 SK3 . This is a "MEDICARE GROUP" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com