=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710281886
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MS. CHELSEA LYNCH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/05/2011
-----------------------------------------------------
Last Update Date | 10/01/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 175 GUNNING RIVER RD BLDG E
-----------------------------------------------------
City | BARNEGAT
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08005-1436
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-660-8002
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 339 W 6TH ST
-----------------------------------------------------
City | SHIP BOTTOM
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08008-4708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 915-526-4056
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------