1073740262 NPI number — MONMOUTH EQUIPMENT & SERVICE

Table of content: (NPI 1073740262)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073740262 NPI number — MONMOUTH EQUIPMENT & SERVICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONMOUTH EQUIPMENT & SERVICE
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:
GARDEN STATE SCOOTERS
Provider Other Organization Name Type Code:
3
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:
1073740262
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5105 ROUTE 33 # 34
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALL TOWNSHIP
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07727-4003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-919-1444
Provider Business Mailing Address Fax Number:
732-919-0256

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 W SOMERDALE RD
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
VOORHEES
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08043-2200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-428-1000
Provider Business Practice Location Address Fax Number:
856-428-1186
Provider Enumeration Date:
06/16/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MORTON
Authorized Official First Name:
EUGENE
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
732-919-1444

Provider Taxonomy Codes

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

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