1790367431 NPI number — COBBLESTONE KIDS PEDIATRIC DENTISTRY OF NEW JERSEY

Table of content: MRS. MARIA AUGUSTA ARTENCIO VILLANI PHYSICAL THERAPIST (NPI 1386286649)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790367431 NPI number — COBBLESTONE KIDS PEDIATRIC DENTISTRY OF NEW JERSEY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COBBLESTONE KIDS PEDIATRIC DENTISTRY OF NEW JERSEY
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:
1790367431
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1352 SOUTH ST STE C4
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19147-1858
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
267-909-9551
Provider Business Mailing Address Fax Number:
267-909-9761

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17 W ORMOND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHERRY HILL
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08002-3041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-288-1929
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/22/2021

Additional Information

Authorized Official

Authorized Official Last Name:
MELIDOSIAN
Authorized Official First Name:
KATE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF OPERATIONS
Authorized Official Telephone Number:
267-909-9551

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com