1184734204 NPI number — MOVSHOVICH PC

Table of content: (NPI 1184734204)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184734204 NPI number — MOVSHOVICH PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOVSHOVICH PC
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:
1184734204
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/11/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
596 ANDERSON AVE
Provider Second Line Business Mailing Address:
STE 101
Provider Business Mailing Address City Name:
CLIFFSIDE PARK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-943-0022
Provider Business Mailing Address Fax Number:
201-313-7146

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
596 ANDERSON AVE
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
CLIFFSIDE PARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-943-0022
Provider Business Practice Location Address Fax Number:
201-313-7146
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MOVSHOVICH
Authorized Official First Name:
ALEXANDER
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
201-943-0022

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  MA68142 , 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: 3H0761 . This is a "BCBS OF NJ" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 5403626 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7134909 . This is a "CIGNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 7964200 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1826249 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P1907446 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P00014540 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 032984Q95 . This is a "MEDICARE RENDERING NUMBER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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