1124024922 NPI number — SPECTRA EAST, INC.

Table of content: (NPI 1124024922)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124024922 NPI number — SPECTRA EAST, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPECTRA EAST, 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:
1124024922
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/25/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8 KING RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKLEIGH
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07647-2502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-767-7070
Provider Business Mailing Address Fax Number:
201-799-4551

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8 KING RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKLEIGH
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07647-2502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-767-7070
Provider Business Practice Location Address Fax Number:
201-799-4551
Provider Enumeration Date:
06/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
CHURCHILL
Authorized Official First Name:
CHRIS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
781-699-2306

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  0001348 , 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: 0017643320002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 071470101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 37000007 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2138672 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 690008572 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 009912670 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02010011 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004996909 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 030641000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0805955 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5580063000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003106160 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30800684 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000843488A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8086605 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7001179 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 030641000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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