1700076254 NPI number — JUDITH C SHAIN-ALVARO PA-C

Table of content: JUDITH C SHAIN-ALVARO PA-C (NPI 1700076254)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700076254 NPI number — JUDITH C SHAIN-ALVARO PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHAIN-ALVARO
Provider First Name:
JUDITH
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHAIN
Provider Other First Name:
JUDITH
Provider Other Middle Name:
C
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1700076254
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/31/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
UNIVERSITY RADIOLOGY GROUP, PC
Provider Second Line Business Mailing Address:
579A CRANBURY ROAD
Provider Business Mailing Address City Name:
EAST BRUNSWICK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08816-1075
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-390-0040
Provider Business Mailing Address Fax Number:
732-390-1856

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
579A CRANBURY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST BRUNSWICK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08816-5426
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-390-0040
Provider Business Practice Location Address Fax Number:
732-390-1856
Provider Enumeration Date:
07/31/2007

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: 363A00000X , with the licence number:  25MP00003500 , 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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