1588619381 NPI number — MRS. MATICA ELANA BIERSTEIN D.C.

Table of content: MRS. MATICA ELANA BIERSTEIN D.C. (NPI 1588619381)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588619381 NPI number — MRS. MATICA ELANA BIERSTEIN D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BIERSTEIN
Provider First Name:
MATICA
Provider Middle Name:
ELANA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COHEN
Provider Other First Name:
MATICA
Provider Other Middle Name:
ELANA
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.C.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1588619381
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
428 RIDGE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAYTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08810-1318
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-329-1300
Provider Business Mailing Address Fax Number:
732-329-3232

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
428 RIDGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAYTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08810-1318
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-329-1300
Provider Business Practice Location Address Fax Number:
732-329-3232
Provider Enumeration Date:
05/23/2006

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: 111N00000X , with the licence number:  MC03438 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111N00000X , with the licence number: CH5717 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 938420 . This is a "HEALTHNET ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3412504 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 602074 . This is a "AETNA PROVIDER ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0115919000 . This is a "AMERIHEALTH ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: P413296 . This is a "OXFORD ID" identifier . This identifiers is of the category "OTHER".




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