1619400256 NPI number — MRS. CHRISTINE LAUREN LIMONGELLO MA, EDS, NCSP

Table of content: MRS. CHRISTINE LAUREN LIMONGELLO MA, EDS, NCSP (NPI 1619400256)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619400256 NPI number — MRS. CHRISTINE LAUREN LIMONGELLO MA, EDS, NCSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIMONGELLO
Provider First Name:
CHRISTINE
Provider Middle Name:
LAUREN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA, EDS, NCSP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DERISO
Provider Other First Name:
CHRISTINE
Provider Other Middle Name:
LAUREN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA, EDS, NCSP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1619400256
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/11/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 JENNIFER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOWELL
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07731-2368
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-581-4443
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 JENNIFER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOWELL
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07731-2368
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-581-4443
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/11/2017

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: 103TS0200X , with the licence number:  646827 , 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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