1750749461 NPI number — MS. ALLYN RUTH SITJAR-NERSESIAN RDT, LCAT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750749461 NPI number — MS. ALLYN RUTH SITJAR-NERSESIAN RDT, LCAT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SITJAR-NERSESIAN
Provider First Name:
ALLYN
Provider Middle Name:
RUTH
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RDT, LCAT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SITJAR
Provider Other First Name:
ALLYN
Provider Other Middle Name:
RUTH
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RDT, LCAT
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1750749461
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/09/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
43 MAIN ST
Provider Second Line Business Mailing Address:
OFFICE SUITE 101, ACTION ARTS CENTER
Provider Business Mailing Address City Name:
SPARTA
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07871-1972
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-415-5329
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
43 MAIN ST
Provider Second Line Business Practice Location Address:
OFFICE SUITE 101, ACTION ARTS CENTER
Provider Business Practice Location Address City Name:
SPARTA
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07871-1972
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-415-5329
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/09/2016

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: 221700000X , with the licence number:  000657-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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