1891969374 NPI number — EVELYN TASHJIAN AMBROSE ADVANCE PRACTICE NUR

Table of content: EVELYN TASHJIAN AMBROSE ADVANCE PRACTICE NUR (NPI 1891969374)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891969374 NPI number — EVELYN TASHJIAN AMBROSE ADVANCE PRACTICE NUR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AMBROSE
Provider First Name:
EVELYN
Provider Middle Name:
TASHJIAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ADVANCE PRACTICE NUR
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:
1891969374
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
249 UNIVERSITY AVE
Provider Second Line Business Mailing Address:
RUTGERS UNIVERSITY HEALTH SERVICES RM 104
Provider Business Mailing Address City Name:
NEWARK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07102-1808
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-353-5231
Provider Business Mailing Address Fax Number:
973-353-1390

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
249 UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
RUTGERS UNIVERSITY HEALTH SERVICES RM 104
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07102-1808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-353-5231
Provider Business Practice Location Address Fax Number:
973-353-1390
Provider Enumeration Date:
04/16/2008

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: 364SA2200X , with the licence number:  26NN02749100 , 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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