1285983023 NPI number — MRS. LINDSAY MADELEINE PECK SPOHN PA-C

Table of content: MRS. LINDSAY MADELEINE PECK SPOHN PA-C (NPI 1285983023)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285983023 NPI number — MRS. LINDSAY MADELEINE PECK SPOHN PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPOHN
Provider First Name:
LINDSAY
Provider Middle Name:
MADELEINE PECK
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
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:
1285983023
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
661 POMPTON AVE
Provider Second Line Business Mailing Address:
APT 4
Provider Business Mailing Address City Name:
CEDAR GROVE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07009-1730
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-565-3169
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 PROSPECT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HACKENSACK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07601-1914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-565-3169
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/07/2012

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: 363A00000X , with the licence number:  25MP00290900 , 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)





Copyright © 2007-2024 www.npivalidator.com