1770626822 NPI number — MS. CYNTHIA ANN WETHERELL A.T.,C.

Table of content: MS. CYNTHIA ANN WETHERELL A.T.,C. (NPI 1770626822)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770626822 NPI number — MS. CYNTHIA ANN WETHERELL A.T.,C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WETHERELL
Provider First Name:
CYNTHIA
Provider Middle Name:
ANN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
A.T.,C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WETHERELL-CARTER
Provider Other First Name:
CYNTHIA
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
A.T.,C.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1770626822
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15 LOUISIANA PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08527-2143
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-961-3881
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
281 ELTON ADELPHIA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREEHOLD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07728-9211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-431-8460
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/15/2007

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: 2255A2300X , with the licence number:  25MT00027800 , 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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