1558595801 NPI number — MRS. CYNTHIA LOUISE MALIN APN

Table of content: CHERYL RICHTER CRNA (NPI 1063448199)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558595801 NPI number — MRS. CYNTHIA LOUISE MALIN APN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MALIN
Provider First Name:
CYNTHIA
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
MRS.
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:
1558595801
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/19/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 GROVE ST
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
HADDON HEIGHTS
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08035-1761
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-796-9200
Provider Business Mailing Address Fax Number:
856-796-9397

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1113 HOSPITAL DR
Provider Second Line Business Practice Location Address:
1ST FLOOR
Provider Business Practice Location Address City Name:
WILLINGBORO
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08046-1103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-835-5821
Provider Business Practice Location Address Fax Number:
609-835-5827
Provider Enumeration Date:
05/14/2009

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: 363L00000X , with the licence number:  SP010300 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X , with the licence number: SP010300 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X , with the licence number: 26NJ00283000 , 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: SP010300 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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