1265514848 NPI number — KEITH J. ALEXANDER, PH.D., P.C.

Table of content: (NPI 1265514848)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265514848 NPI number — KEITH J. ALEXANDER, PH.D., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KEITH J. ALEXANDER, PH.D., P.C.
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:
INTERCHANGE
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:
1265514848
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2079 KLOCKNER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMILTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08690-3415
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-586-0444
Provider Business Mailing Address Fax Number:
609-586-6292

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2079 KLOCKNER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMILTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08690-3415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-586-0444
Provider Business Practice Location Address Fax Number:
609-586-6292
Provider Enumeration Date:
10/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ALEXANDER
Authorized Official First Name:
KEITH
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
609-586-0444

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  35S100326600 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: 2952 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TH0004X , with the licence number: 35SI00324900 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 44SC601700 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , with the licence number: 37FI00157200 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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