1992763023 NPI number — MARYANN BIANCIELLA-THOMAS DO

Table of content: MARYANN BIANCIELLA-THOMAS DO (NPI 1992763023)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992763023 NPI number — MARYANN BIANCIELLA-THOMAS DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BIANCIELLA-THOMAS
Provider First Name:
MARYANN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1992763023
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8500-2721
Provider Second Line Business Mailing Address:
CHILTON EMERGENCY PHYSICIANS LLC
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19178-2721
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-777-2455
Provider Business Mailing Address Fax Number:
610-617-6280

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
97 WEST PARKWAY
Provider Second Line Business Practice Location Address:
CHILTON MEMORIAL HOSPITAL
Provider Business Practice Location Address City Name:
POMPTON PLAINS
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07444
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-831-5000
Provider Business Practice Location Address Fax Number:
201-444-3604
Provider Enumeration Date:
05/01/2006

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: 207P00000X , with the licence number:  25MB07148300 , 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: 8820601 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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