1801483888 NPI number — SHELLINIE D MUNESHWAR NP

Table of content: SHELLINIE D MUNESHWAR NP (NPI 1801483888)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801483888 NPI number — SHELLINIE D MUNESHWAR NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MUNESHWAR
Provider First Name:
SHELLINIE
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MUNESHWAR
Provider Other First Name:
SHELLINIE
Provider Other Middle Name:
D
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
NP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1801483888
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/24/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
67 JEFFERSON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JERSEY CITY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07306-1017
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
155-135-8626
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
585 RIDGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH ARLINGTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07031-4823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-997-0333
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/24/2020

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:  26NJ01079000 , 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)