1134459258 NPI number — SANFORD HEIGHTS HEARING CENTER INC.

Table of content: (NPI 1134459258)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134459258 NPI number — SANFORD HEIGHTS HEARING CENTER INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SANFORD HEIGHTS HEARING CENTER 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:
1134459258
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/27/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1984 SPRINGFIELD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAPLEWOOD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07040-3437
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-275-1006
Provider Business Mailing Address Fax Number:
973-275-1106

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1984 SPRINGFIELD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAPLEWOOD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07040-3437
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-275-1006
Provider Business Practice Location Address Fax Number:
973-275-1106
Provider Enumeration Date:
01/12/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
OKEKE
Authorized Official First Name:
IRENE
Authorized Official Middle Name:
N
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
973-275-1006

Provider Taxonomy Codes

  • Taxonomy code: 302F00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4501171 . This is a "AETNA NON-HMO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 3909476000 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 60015958 . This is a "HORIZON NJ HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1007016 . This is a "AETNA HMO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 5352908 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".