1598916397 NPI number — MRS. NICOLE LYNN SOLORZANO DPT

Table of content: MRS. NICOLE LYNN SOLORZANO DPT (NPI 1598916397)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598916397 NPI number — MRS. NICOLE LYNN SOLORZANO DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOLORZANO
Provider First Name:
NICOLE
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
DPT
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:
1598916397
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/24/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2500 ENGLISH CREEK AVE
Provider Second Line Business Mailing Address:
BLDG 1300
Provider Business Mailing Address City Name:
EGG HARBOR TOWNSHIP
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08234-5549
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-677-7002
Provider Business Mailing Address Fax Number:
609-383-5197

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2500 ENGLISH CREEK AVE
Provider Second Line Business Practice Location Address:
BLDG 1300
Provider Business Practice Location Address City Name:
EGG HARBOR TOWNSHIP
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08234-5549
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-677-7002
Provider Business Practice Location Address Fax Number:
609-383-5197
Provider Enumeration Date:
10/10/2008

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: 225100000X , with the licence number:  40QA01295300 , 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)





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