1629602305 NPI number — DR. MELISSA CLARE O'MALLEY AU.D.

Table of content: CHRISTINE BRASSFIELD LCSW (NPI 1407642390)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629602305 NPI number — DR. MELISSA CLARE O'MALLEY AU.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
O'MALLEY
Provider First Name:
MELISSA
Provider Middle Name:
CLARE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
AU.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LOHIN
Provider Other First Name:
MELISSA
Provider Other Middle Name:
CLARE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
AU.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1629602305
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/03/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
112 WINDHAM CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18940-1749
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-200-2399
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 CAPITAL WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PENNINGTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08534-2520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-303-4718
Provider Business Practice Location Address Fax Number:
609-303-4132
Provider Enumeration Date:
03/03/2020

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: 237600000X , with the licence number:  41YA00104100 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 237700000X , with the licence number: 25MG00153200 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 231H00000X , with the licence number: 41YA00104100 , 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: 41YA00104100 . This is a "AUDIOLOGY LICENSE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 25MG00153200 . This is a "HEARING AID DISPENSING LICENSE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".