1013086586 NPI number — PRESBYTERIAN HOMES OF SOUTHERN NEW JERSEY, INC

Table of content: (NPI 1013086586)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013086586 NPI number — PRESBYTERIAN HOMES OF SOUTHERN NEW JERSEY, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRESBYTERIAN HOMES OF SOUTHERN NEW JERSEY, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013086586
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13 ROSZEL RD
Provider Second Line Business Mailing Address:
SUITE C120
Provider Business Mailing Address City Name:
PRINCETON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08540-6211
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-987-8900
Provider Business Mailing Address Fax Number:
609-720-7247

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
132 WARWICK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HADDONFIELD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08033-3707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-429-5500
Provider Business Practice Location Address Fax Number:
856-429-1097
Provider Enumeration Date:
11/07/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PUMA
Authorized Official First Name:
GARY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT-CEO
Authorized Official Telephone Number:
609-987-8900

Provider Taxonomy Codes

  • Taxonomy code: 310400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7902603 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".