1215101753 NPI number — CPC BEHAVIORAL HEALTHCARE

Table of content: (NPI 1215101753)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215101753 NPI number — CPC BEHAVIORAL HEALTHCARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CPC BEHAVIORAL HEALTHCARE
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:
1215101753
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 INDUSTRIAL WAY E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EATONTOWN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07724-3332
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-395-2260
Provider Business Mailing Address Fax Number:
732-389-3207

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1088 HIGHWAY 34
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ABERDEEN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07747-1948
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-290-1700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/16/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SANTORA
Authorized Official First Name:
STELLA
Authorized Official Middle Name:
Authorized Official Title or Position:
PATIENT ACCTS MGR
Authorized Official Telephone Number:
732-935-2260

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 701378 . This is a "MEDICARE PROVIDER #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 540055 . This is a "MEDICARE PROVIDER #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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