1649724816 NPI number — COLLEEN DI LUIGI

Table of content: COLLEEN DI LUIGI (NPI 1649724816)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649724816 NPI number — COLLEEN DI LUIGI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DI LUIGI
Provider First Name:
COLLEEN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1649724816
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 FEDERAL ST STE SW200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMDEN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08103-1155
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-356-4924
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
196 GROVE AVENUE
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
THOROFARE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08086
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-848-7577
Provider Business Practice Location Address Fax Number:
856-848-6554
Provider Enumeration Date:
08/05/2016

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: 363LF0000X , with the licence number:  26NJ00640700 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: SP016210 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0550558 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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