1669656815 NPI number — ANDREA JILL REIN APN

Table of content: ANDREA JILL REIN APN (NPI 1669656815)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669656815 NPI number — ANDREA JILL REIN APN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REIN
Provider First Name:
ANDREA
Provider Middle Name:
JILL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STORPER
Provider Other First Name:
ANDREA
Provider Other Middle Name:
JILL
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
APN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1669656815
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/08/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
407 CONCORD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRESSKILL
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07626-1201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-567-3045
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
223 N VAN DIEN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIDGEWOOD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07450-2726
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-447-8418
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/24/2007

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: 363LA2100X , with the licence number:  26NN08459100 , 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)