1518032192 NPI number — DR. MONA WELLER BIRK PHD, APN

Table of content: DR. MONA WELLER BIRK PHD, APN (NPI 1518032192)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518032192 NPI number — DR. MONA WELLER BIRK PHD, APN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BIRK
Provider First Name:
MONA
Provider Middle Name:
WELLER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD, APN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WELLER
Provider Other First Name:
MONA
Provider Other Middle Name:
LOIS
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1518032192
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/24/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
32 HOPKINSON CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BASKING RIDGE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07920-2982
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-306-0774
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
32 HOPKINSON CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BASKING RIDGE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07920-2982
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-306-0774
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/21/2006

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: 103TA0700X , with the licence number:  35S100409300 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: 35S100409300 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC1900X , with the licence number: 35S100409300 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TF0000X , with the licence number: 35S100409300 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TM1800X , with the licence number: 35S100409300 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TR0400X , with the licence number: 35S100409300 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X , with the licence number: 44SW00117700 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , with the licence number: 37F100122400 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163W00000X , with the licence number: 26NR04510500 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WP0809X , with the licence number: 26NR04510500 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364S00000X , with the licence number: 26NC04510500 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103T00000X , with the licence number: 35S100409300 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 016408DBG . This is a "MEDICARE ID-CNS-INHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 076509DBG . This is a "MEDICARE ID-PHD-INHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 076509APU . This is a "MEDICARE ID-PHD-ROSSI" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 4144007 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0023850 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 143411APU . This is a "MEDICARE ID-CNS-ROSSI" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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