1609820703 NPI number — VIRGINIA S JU CRNA

Table of content: VIRGINIA S JU CRNA (NPI 1609820703)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609820703 NPI number — VIRGINIA S JU CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JU
Provider First Name:
VIRGINIA
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
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:
1609820703
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/17/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 ROUTE 59 STE 105
Provider Second Line Business Mailing Address:
RAMAPO ANESTHESIOLOGISTS, PC
Provider Business Mailing Address City Name:
SUFFERN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10901-4927
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-357-5775
Provider Business Mailing Address Fax Number:
845-357-5777

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
255 LAFAYETTE AVE
Provider Second Line Business Practice Location Address:
RAMAPO ANESTHESIOLOGISTS, PC
Provider Business Practice Location Address City Name:
SUFFERN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10901-4812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-368-5039
Provider Business Practice Location Address Fax Number:
845-368-5327
Provider Enumeration Date:
05/22/2006

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: 367500000X , with the licence number:  499162 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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