1790554848 NPI number — MRS. VICTORIA ELLEN PACHYTEL APN

Table of content: MRS. VICTORIA ELLEN PACHYTEL APN (NPI 1790554848)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790554848 NPI number — MRS. VICTORIA ELLEN PACHYTEL APN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PACHYTEL
Provider First Name:
VICTORIA
Provider Middle Name:
ELLEN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CLAYTON
Provider Other First Name:
VICTORIA
Provider Other Middle Name:
ELLEN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1790554848
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/16/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
331 NEWMAN SPRINGS RD STE 220
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RED BANK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07701-5688
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-807-0877
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
195 ROUTE 9 STE 106
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANALAPAN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07726-8294
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-536-7144
Provider Business Practice Location Address Fax Number:
732-536-7520
Provider Enumeration Date:
12/29/2023

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:  26NJ14980300 , 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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