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1871604066 NPI number — THERESA ROSE CERULLI MD

NPI Number: 1871604066
Health Care Provider/Practitioner: THERESA ROSE CERULLI MD

Information about “1871604066” NPI (THERESA ROSE CERULLI MD) exists in 1871604066 in HTML format HTML  |  1871604066 in plain Text format TXT  |  1871604066 in PDF (Portable Document Format) PDF  |  1871604066 in an XML format XML  formats.

NPI Number : 1871604066 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1871604066",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "CERULLI",
    "FirstName": "THERESA",
    "MiddleName": "ROSE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "CERULLI-BANKS",
    "OtherFirstName": "THERESA",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "4 BRISTOL LN",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ANDOVER",
    "MailingAddressStateName": "MA",
    "MailingAddressPostalCode": "01810-5813",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "978-475-0592",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "790 TURNPIKE ST",
    "SecondLinePracticeLocationAddress": "SUITE 106",
    "PracticeLocationAddressCityName": "NORTH ANDOVER",
    "PracticeLocationAddressStateName": "MA",
    "PracticeLocationAddressPostalCode": "01845-6144",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "978-683-6065",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/31/2006",
    "LastUpdateDate": "07/08/2007",
    "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": "2084P0800X",
        "TaxonomyName": "Psychiatry Physician",
        "LicenseNumber": "152303",
        "LicenseNumberStateCode": "MA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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