1871268011 NPI number — KELLY ANNE RIVELL APN

Table of content: KELLY ANNE RIVELL APN (NPI 1871268011)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871268011 NPI number — KELLY ANNE RIVELL APN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIVELL
Provider First Name:
KELLY
Provider Middle Name:
ANNE
Provider Name Prefix Text:
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:
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:
1871268011
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/10/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 SAINT REGIS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST DEPTFORD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08096-3928
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-410-7557
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PBF ENERGY
Provider Second Line Business Practice Location Address:
800 BILLINGSPORT ROAD
Provider Business Practice Location Address City Name:
PAULSBOR
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-224-6200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/10/2021

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: 363LG0600X , with the licence number:  26NJ01156100 , 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)

  • Identifier: 26NJ01156100 . This is a "OCCUPATIONAL HEALTH APN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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