1912270034 NPI number — ALICIA M JANUARY PH.D.

Table of content: ALICIA M JANUARY PH.D. (NPI 1912270034)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912270034 NPI number — ALICIA M JANUARY PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JANUARY
Provider First Name:
ALICIA
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JANUARY
Provider Other First Name:
ALI
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1912270034
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/20/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
SHRINERS HOSPITALS FOR CHILDREN
Provider Second Line Business Mailing Address:
P.O. BOX 8500, LOCKBOX 7642
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19178-7642
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-281-8115
Provider Business Mailing Address Fax Number:
813-281-8656

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2211 N OAK PARK AVE
Provider Second Line Business Practice Location Address:
SHRINERS HOSPITALS FOR CHILDREN
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60707-3351
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-385-5585
Provider Business Practice Location Address Fax Number:
773-385-5488
Provider Enumeration Date:
02/21/2012

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: 103TC0700X , with the licence number:  071009075 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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