1174545420 NPI number — S M GOULD MULLIGAN D.P.M.

Table of content: S M GOULD MULLIGAN D.P.M. (NPI 1174545420)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174545420 NPI number — S M GOULD MULLIGAN D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOULD MULLIGAN
Provider First Name:
S
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.P.M.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GOULD
Provider Other First Name:
SANDRA
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.P.M.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1174545420
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
52 BERLIN RD
Provider Second Line Business Mailing Address:
SUITE 5000
Provider Business Mailing Address City Name:
CHERRY HILL
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08034-3574
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-795-1003
Provider Business Mailing Address Fax Number:
856-795-5994

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
52 BERLIN RD
Provider Second Line Business Practice Location Address:
SUITE 5000
Provider Business Practice Location Address City Name:
CHERRY HILL
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08034-3574
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-795-1003
Provider Business Practice Location Address Fax Number:
856-795-5994
Provider Enumeration Date:
07/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  25MD00263000 , 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: 01000464100 . This is a "AMERICHOICE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 51310 . This is a "AMERIGROUP" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 6299205 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8601801 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2008280000 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 7382775 . This is a "CIGNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: IK9329 . This is a "HEALTH NET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1153685 . This is a "HORIZON NJ HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P2524077 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".




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