Basic Information
Provider Information | |||||||||
NPI: | 1396921383 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | ADVANCED ASSIST, LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 1522 | ||||||||
Address2: |   | ||||||||
City: | MILLVILLE | ||||||||
State: | NJ | ||||||||
PostalCode: | 083328522 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8567763295 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 994 W SHERMAN AVE | ||||||||
Address2: |   | ||||||||
City: | VINELAND | ||||||||
State: | NJ | ||||||||
PostalCode: | 083606937 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8566960900 | ||||||||
FaxNumber: | 9736483481 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/21/2008 | ||||||||
LastUpdateDate: | 04/17/2009 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | BERNARDINI | ||||||||
AuthorizedOfficialFirstName: | MARIANNE | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | APN | ||||||||
AuthorizedOfficialTelephone: | 8567763295 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MRS. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | APN | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | 26NJ00135000 | NJ | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.