1114011012 NPI number — PATIENTS FIRST LTD LLC

Table of content: (NPI 1114011012)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114011012 NPI number — PATIENTS FIRST LTD LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PATIENTS FIRST LTD LLC
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:
1114011012
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/20/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
99 FOREST AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLEN RIDGE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07028-2413
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-926-1351
Provider Business Mailing Address Fax Number:
973-926-9164

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11 RIDGE ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH ARLINGTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-998-1800
Provider Business Practice Location Address Fax Number:
201-998-1891
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GASHI
Authorized Official First Name:
SHEREMET
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL PHYSICIAN
Authorized Official Telephone Number:
201-998-1800

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , 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: 5801633 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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