1902426364 NPI number — ELLEN ENGEL

Table of content: ELLEN ENGEL (NPI 1902426364)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902426364 NPI number — ELLEN ENGEL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ENGEL
Provider First Name:
ELLEN
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:
1902426364
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/25/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
213 2ND AVE APT B7
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASBURY PARK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07712-6227
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-800-2204
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
213 2ND AVE APT B7
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASBURY PARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07712-6227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-800-2204
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/25/2020

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: 225700000X , with the licence number:  18KT01364300 , 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: E59152137454942 . This is a "MOTOR VEHICLE COMMISSION" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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