1720223969 NPI number — BEN-EZRA CHIROPRACTIC WELLNESS CENTER

Table of content: KATHLEEN RAE STIGAR CRNA (NPI 1154336998)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720223969 NPI number — BEN-EZRA CHIROPRACTIC WELLNESS CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEN-EZRA CHIROPRACTIC WELLNESS CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1720223969
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24 VILLAGE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAZLET
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07730-1532
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-888-0595
Provider Business Mailing Address Fax Number:
732-888-8351

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24 VILLAGE CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAZLET
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07730-1532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-888-0595
Provider Business Practice Location Address Fax Number:
732-888-8351
Provider Enumeration Date:
12/02/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BEN-EZRA
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
MARK
Authorized Official Title or Position:
DOCTOR OF CHIROPRACTIC
Authorized Official Telephone Number:
732-888-0595

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  38MC00463200 , 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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