1558555227 NPI number — HAZARI MUDULI, MD, LLC

Table of content: DEBRA LYNN OTTEN APRN BC FAMILY NURSE (NPI 1932273166)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558555227 NPI number — HAZARI MUDULI, MD, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAZARI MUDULI, MD, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1558555227
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/01/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
350 SPARTA AVE
Provider Second Line Business Mailing Address:
UNIT B6B
Provider Business Mailing Address City Name:
SPARTA
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07871-1150
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-729-2619
Provider Business Mailing Address Fax Number:
973-729-2604

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
350 SPARTA AVE
Provider Second Line Business Practice Location Address:
UNIT B6B
Provider Business Practice Location Address City Name:
SPARTA
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07871-1150
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-729-2619
Provider Business Practice Location Address Fax Number:
973-729-2604
Provider Enumeration Date:
09/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PATEL
Authorized Official First Name:
JALPA
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
973-729-2619

Provider Taxonomy Codes

  • Taxonomy code: 2086S0129X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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