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1053662379 NPI number — MARC THOMAS MONGEAU D.O.

NPI Number: 1053662379
Health Care Provider/Practitioner: MARC THOMAS MONGEAU D.O.

Information about “1053662379” NPI (MARC THOMAS MONGEAU D.O.) exists in 1053662379 in HTML format HTML  |  1053662379 in plain Text format TXT  |  1053662379 in PDF (Portable Document Format) PDF  |  1053662379 in an XML format XML  formats.

NPI Number : 1053662379 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1053662379",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MONGEAU",
    "FirstName": "MARC",
    "MiddleName": "THOMAS",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "D.O.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "900 MEDICAL CENTER DR STE 205",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SEWELL",
    "MailingAddressStateName": "NJ",
    "MailingAddressPostalCode": "08080-2358",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "844-542-2273",
    "MailingAddressFaxNumber": "856-553-4390",
    "FirstLinePracticeLocationAddress": "435 HURFFVILLE CROSS KEYS RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "TURNERSVILLE",
    "PracticeLocationAddressStateName": "NJ",
    "PracticeLocationAddressPostalCode": "08012",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "856-513-4124",
    "PracticeLocationAddressFaxNumber": "856-302-3926",
    "EnumerationDate": "09/26/2012",
    "LastUpdateDate": "02/01/2019",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "207RP1001X",
        "TaxonomyName": "Pulmonary Disease Physician",
        "LicenseNumber": "25MB10141500",
        "LicenseNumberStateCode": "NJ",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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