1851467245 NPI number — MS. MALKA KOENIG OTR CHT

Table of content: MS. MALKA KOENIG OTR CHT (NPI 1851467245)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851467245 NPI number — MS. MALKA KOENIG OTR CHT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOENIG
Provider First Name:
MALKA
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
OTR CHT
Provider Gender Code:
F

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:
1851467245
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/02/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
238 AYCRIGG AVE
Provider Second Line Business Mailing Address:
UNIT A
Provider Business Mailing Address City Name:
PASSAIC
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07055-4775
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-685-9177
Provider Business Mailing Address Fax Number:
973-246-9176

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
238 AYCRIGG AVE
Provider Second Line Business Practice Location Address:
UNIT A
Provider Business Practice Location Address City Name:
PASSAIC
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07055-4775
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-685-9177
Provider Business Practice Location Address Fax Number:
973-246-9176
Provider Enumeration Date:
11/28/2006

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: 225X00000X , with the licence number:  006396 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X , with the licence number: 46TR00455400 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XH1200X , with the licence number: 9911000100 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225XH1200X , with the licence number: 9911000100 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 03500600 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1370057 . This is a "UHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1699825 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 02284715 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: P2665470 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7185402 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 811127 . This is a "MPN" identifier . This identifiers is of the category "OTHER".
  • Identifier: P11211193 . This is a "MULTIPLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: QS5832 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".




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