1962584672 NPI number — MELINDA JOY ROSEN OTR

Table of content: MELINDA JOY ROSEN OTR (NPI 1962584672)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962584672 NPI number — MELINDA JOY ROSEN OTR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSEN
Provider First Name:
MELINDA
Provider Middle Name:
JOY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OTR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TURNER
Provider Other First Name:
MELINDA
Provider Other Middle Name:
JOY
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
OTR OTRC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1962584672
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/18/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
94 AMHERST ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AMHERST
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03031
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-886-0579
Provider Business Mailing Address Fax Number:
603-886-0163

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 BAYSIDE RD # 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENLAND
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03840-2117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-373-0014
Provider Business Practice Location Address Fax Number:
603-433-6787
Provider Enumeration Date:
10/20/2006

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: 225XP0200X , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 020377315 . This is a "COMM TAX ID" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 561822 . This is a "AETNA" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 272746 . This is a "CIGNA" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 626514 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 761242 . This is a "TUFTS" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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