1174564421 NPI number — ENGLEWOOD MEDICAL ASSOCIATES INC

Table of content: (NPI 1174564421)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174564421 NPI number — ENGLEWOOD MEDICAL ASSOCIATES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ENGLEWOOD MEDICAL ASSOCIATES 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:
EMERGENCY PHYSICIANS OF EMA INC
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:
1174564421
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 48310
Provider Second Line Business Mailing Address:
EMERGENCY PHYSICIANS OF EMA INC
Provider Business Mailing Address City Name:
NEWARK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07101-4810
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-666-2455
Provider Business Mailing Address Fax Number:
610-617-6280

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
350 ENGLE ST
Provider Second Line Business Practice Location Address:
ENGLEWOOD HOSPITAL & MEDICAL CENTER
Provider Business Practice Location Address City Name:
ENGLEWOOD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07631-1808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-984-3000
Provider Business Practice Location Address Fax Number:
610-617-6280
Provider Enumeration Date:
06/09/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PIETROWICZ
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
D
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
201-894-3005

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7497903 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".