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1811213929 NPI number — DR. LAUREN KOSTELNIK KOVALCHIK

NPI Number: 1811213929
Health Care Provider/Practitioner: DR. LAUREN KOSTELNIK KOVALCHIK

Information about “1811213929” NPI (DR. LAUREN KOSTELNIK KOVALCHIK) exists in 1811213929 in HTML format HTML  |  1811213929 in plain Text format TXT  |  1811213929 in PDF (Portable Document Format) PDF  |  1811213929 in an XML format XML  formats.

NPI Number : 1811213929 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1811213929",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "KOVALCHIK",
    "FirstName": "LAUREN",
    "MiddleName": "KOSTELNIK",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "205 MARTINS LN",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MEDIA",
    "MailingAddressStateName": "PA",
    "MailingAddressPostalCode": "19063-5854",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "610-357-4925",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1304 LAUREL OAK RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "VOORHEES",
    "PracticeLocationAddressStateName": "NJ",
    "PracticeLocationAddressPostalCode": "08043-4310",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "888-873-5437",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/14/2010",
    "LastUpdateDate": "04/29/2025",
    "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": "208000000X",
          "TaxonomyName": "Pediatrics Physician",
          "LicenseNumber": "25MA12497000",
          "LicenseNumberStateCode": "NJ",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "208000000X",
          "TaxonomyName": "Pediatrics Physician",
          "LicenseNumber": "MD448445",
          "LicenseNumberStateCode": "PA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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