1619036753 NPI number — DR. STACIE VERNICK PERDUE PH.D.

Table of content: DR. STACIE VERNICK PERDUE PH.D. (NPI 1619036753)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619036753 NPI number — DR. STACIE VERNICK PERDUE PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PERDUE
Provider First Name:
STACIE
Provider Middle Name:
VERNICK
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VERNICK
Provider Other First Name:
STACIE
Provider Other Middle Name:
H
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PH.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1619036753
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:
51 SOUTH ST
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
MORRISTOWN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07960-8106
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-539-5600
Provider Business Mailing Address Fax Number:
973-539-5625

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
51 SOUTH ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
MORRISTOWN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07960-8106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-539-5600
Provider Business Practice Location Address Fax Number:
973-539-5625
Provider Enumeration Date:
12/06/2006

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: 103T00000X , with the licence number:  4381 , 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)





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