1730665704 NPI number — MS. MERA BELLE GAMO DUMALAG NP-C

Table of content: MS. MERA BELLE GAMO DUMALAG NP-C (NPI 1730665704)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730665704 NPI number — MS. MERA BELLE GAMO DUMALAG NP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUMALAG
Provider First Name:
MERA BELLE
Provider Middle Name:
GAMO
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
NP-C
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:
1730665704
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/04/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1-21 SUMMIT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIR LAWN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07410-2044
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-773-0365
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
510 HAMBURG TPKE STE 208
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAYNE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07470-2033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-904-3480
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/12/2018

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:  26NJ00822500 , 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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