1881365823 NPI number — ASHLEY GLYNN

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881365823 NPI number — ASHLEY GLYNN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GLYNN
Provider First Name:
ASHLEY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1881365823
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/21/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23 WARREN PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH MIDDLETOWN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07748-5931
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-461-1954
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 MILLSTONE RD STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST WINDSOR
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08520-1415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-392-4900
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/21/2021

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: 106S00000X , with the licence number:  RBT-21-163938 , 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: RBT-21-163938 . This is a "RBT NUMBER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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