1275793960 NPI number — CUREXA- EAST II, LLC

Table of content: (NPI 1275793960)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275793960 NPI number — CUREXA- EAST II, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CUREXA- EAST II, LLC
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:
CUREXA
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:
1275793960
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/13/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
236 E JIMMIE LEEDS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GALLOWAY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08205-4134
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
855-927-0390
Provider Business Mailing Address Fax Number:
855-927-0392

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
236 E JIMMIE LEEDS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GALLOWAY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08205-4134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
855-927-0390
Provider Business Practice Location Address Fax Number:
855-927-0392
Provider Enumeration Date:
06/16/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TAYLOR
Authorized Official First Name:
MARK
Authorized Official Middle Name:
KELSO
Authorized Official Title or Position:
CEO AND PRESIDENT
Authorized Official Telephone Number:
855-927-0390

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  PH30902 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 4936 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: P07694 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 64002509A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: NRP.022794050-03 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 054020699 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: NP000289 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 28RS00680600 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0003X , with the licence number: 126560 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 1195 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: A9-0002128 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PHNR001356 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 036078 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PH03889 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PCN.0003369 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 102467890 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2056311 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 28RS00785700 . This is a "HOME STATE ISSUED PHARMACY LICENSE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0183822 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".