1023007408 NPI number — ACUTE CARE SPECIALISTS INC

Table of content: (NPI 1023007408)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023007408 NPI number — ACUTE CARE SPECIALISTS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACUTE CARE SPECIALISTS 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:
1023007408
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
144 LOWER MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MATAWAN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07747-1040
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-583-8003
Provider Business Mailing Address Fax Number:
732-583-6335

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
144 LOWER MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MATAWAN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07747-1040
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-583-8003
Provider Business Practice Location Address Fax Number:
732-583-6335
Provider Enumeration Date:
10/18/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DISANZA
Authorized Official First Name:
WAYNE
Authorized Official Middle Name:
W
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
732-583-8003

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 10994 . This is a "UNIVERSITY HEALTH PLAN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 4614607 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1036698 . This is a "HORIZON NEW JERSEY HEALTH" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 21575 . This is a "AMERIGROUP" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".