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1396306031 NPI number — MARILYN (LYNN) G TEALE

NPI Number: 1396306031
Health Care Provider/Practitioner: MARILYN (LYNN) G TEALE

Information about “1396306031” NPI (MARILYN (LYNN) G TEALE) exists in 1396306031 in HTML format HTML  |  1396306031 in plain Text format TXT  |  1396306031 in PDF (Portable Document Format) PDF  |  1396306031 in an XML format XML  formats.

NPI Number : 1396306031 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1396306031",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "TEALE",
    "FirstName": "MARILYN (LYNN)",
    "MiddleName": "G",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "30 PETERSBURG RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "HACKETTSTOWN",
    "MailingAddressStateName": "NJ",
    "MailingAddressPostalCode": "07840-4902",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "845-473-0468",
    "MailingAddressFaxNumber": "845-625-1482",
    "FirstLinePracticeLocationAddress": "1248 SUSSEX TPK",
    "SecondLinePracticeLocationAddress": "UNIT B11",
    "PracticeLocationAddressCityName": "RANDOLPH",
    "PracticeLocationAddressStateName": "NJ",
    "PracticeLocationAddressPostalCode": "07869",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "973-440-8370",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/24/2019",
    "LastUpdateDate": "06/24/2019",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "2255A2300X",
        "TaxonomyName": "Athletic Trainer",
        "LicenseNumber": "2004AF",
        "LicenseNumberStateCode": "MD",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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